MEDICARE: TARA ADELLE GARDENHIRE LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YM0800X	Mental Health Counselor	LMFT-15549	AZ

General Provider Information

NPI Number	:	1770808503
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA ADELLE GARDENHIRE LMFT

Provider Business Mailing Address
First Line	:	1600 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3119
Country	:	US
Telephone Number	:	520-327-4505
Fax Number	:

Provider Business Practice Location Address
First Line	:	1600 N COUNTRY CLUB RD
Second Line	:
City	:	TUCSON
State	:	AZ
Zip	:	85716-3119
Country	:	US
Telephone Number	:	520-327-4505
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/05/2010
Last Update Date	:	08/19/2021

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