Provider Demographics
NPI:1487351250
Name:VAZQUEZ-ALARCON, TARA KAY (PLDAC, SW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KAY
Last Name:VAZQUEZ-ALARCON
Suffix:
Gender:F
Credentials:PLDAC, SW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:KAY
Other - Last Name:WRIGHT
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1152 RENAE LN
Mailing Address - Street 2:
Mailing Address - City:HASTINGS
Mailing Address - State:NE
Mailing Address - Zip Code:68901-6815
Mailing Address - Country:US
Mailing Address - Phone:308-750-3767
Mailing Address - Fax:
Practice Address - Street 1:835 S BURLINGTON AVE STE 115
Practice Address - Street 2:
Practice Address - City:HASTINGS
Practice Address - State:NE
Practice Address - Zip Code:68901-6928
Practice Address - Country:US
Practice Address - Phone:402-462-2066
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-02-13
Last Update Date:2023-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE3231104100000X
NEP1633101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No104100000XBehavioral Health & Social Service ProvidersSocial Worker