Provider Demographics
NPI:1053548370
Name:REED, TARA (MA, NCC, LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:REED
Suffix:
Gender:F
Credentials:MA, NCC, LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:REED
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, NCC, LPC
Mailing Address - Street 1:1800 WEST 4-J RD
Mailing Address - Street 2:
Mailing Address - City:GILLETTE
Mailing Address - State:WY
Mailing Address - Zip Code:82718-6656
Mailing Address - Country:US
Mailing Address - Phone:307-682-5433
Mailing Address - Fax:
Practice Address - Street 1:1800 WEST 4-J RD.
Practice Address - Street 2:
Practice Address - City:GILLETTE
Practice Address - State:WY
Practice Address - Zip Code:82718
Practice Address - Country:US
Practice Address - Phone:307-682-5433
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-06-12
Last Update Date:2021-02-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1642101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional