Provider Demographics
NPI:1528772837
Name:FALCON, TARA KAYE (CADC II A051610120)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:KAYE
Last Name:FALCON
Suffix:
Gender:F
Credentials:CADC II A051610120
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E MARKET ST
Mailing Address - Street 2:
Mailing Address - City:LONG BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90805-5924
Mailing Address - Country:US
Mailing Address - Phone:562-428-4222
Mailing Address - Fax:
Practice Address - Street 1:100 E MARKET ST
Practice Address - Street 2:
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90805-5924
Practice Address - Country:US
Practice Address - Phone:562-428-4222
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAA051610120101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)