Russell, Tara Nicole

Russell, Tara Nicole is an individual health care provider with primary practice located at 6550 E Broadway Rd Ste 110 , Mesa AZ 85206-1734. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder), Behavioral Health & Social Service Providers / Behavioral Analyst. Behavioral Health & Social Service Providers / Behavioral Analyst is her primary health care specialty. Russell, Tara Nicole can be contacted via phone (480) 672-0772.

Contact Information

Primary practice address
6550 E Broadway Rd Ste 110 Mesa AZ 85206-1734
Phone: (480) 672-0772
Fax: (317) 520-8200
Website:
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Health care specialties

SpecialtyCodeLicense #State
Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) 101YA0400X
Behavioral Health & Social Service Providers / Behavioral Analyst 103K00000X BEH-000896 Arizona

Profile Details

NPI number 1649429465
LBN Legal business name Russell, Tara Nicole
Credentials MS, BCBA, LBA
Entity Individual
Sole proprietor 1 No
Enumeration date Sep 17th, 2008
Last updated May 1st, 2023 - about last year

1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.

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Identifiers

StateTypeNumberIssuer
All States NPI 1649429465 NPPES
Other 1-21-48060 BCBA CERTIFICATE

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