Provider Demographics
NPI:1154752244
Name:FARRELL, TARA K (LPCC, LMHC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:K
Last Name:FARRELL
Suffix:
Gender:F
Credentials:LPCC, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 391
Mailing Address - Street 2:
Mailing Address - City:CAZADERO
Mailing Address - State:CA
Mailing Address - Zip Code:95421-0391
Mailing Address - Country:US
Mailing Address - Phone:206-786-6672
Mailing Address - Fax:
Practice Address - Street 1:6914 SEBASTOPOL AVE STE B
Practice Address - Street 2:
Practice Address - City:SEBASTOPOL
Practice Address - State:CA
Practice Address - Zip Code:95472-3460
Practice Address - Country:US
Practice Address - Phone:206-488-2143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-27
Last Update Date:2022-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60611750101YM0800X, 101YM0800X
CALPCC11768101YM0800X
WAMC60442665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health