Provider Demographics
NPI:1912476045
Name:PANNELL, TARA BETH (LPC, NBCC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:BETH
Last Name:PANNELL
Suffix:
Gender:F
Credentials:LPC, NBCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7448 SCHOYER AVE
Mailing Address - Street 2:
Mailing Address - City:PITTSBURGH
Mailing Address - State:PA
Mailing Address - Zip Code:15218-2316
Mailing Address - Country:US
Mailing Address - Phone:412-425-2530
Mailing Address - Fax:
Practice Address - Street 1:1301 S BRADDOCK AVE FL 1
Practice Address - Street 2:
Practice Address - City:PITTSBURGH
Practice Address - State:PA
Practice Address - Zip Code:15218-1251
Practice Address - Country:US
Practice Address - Phone:412-425-2530
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-11-19
Last Update Date:2020-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC010896101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional