Provider Demographics
NPI:1962127969
Name:CHASE, TARA LYNNE (LAC, MS, NCC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:LYNNE
Last Name:CHASE
Suffix:
Gender:F
Credentials:LAC, MS, NCC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNNE
Other - Last Name:BASSELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LAC, NCC
Mailing Address - Street 1:13916 N 135TH DR
Mailing Address - Street 2:
Mailing Address - City:SURPRISE
Mailing Address - State:AZ
Mailing Address - Zip Code:85379-8428
Mailing Address - Country:US
Mailing Address - Phone:623-462-8187
Mailing Address - Fax:
Practice Address - Street 1:1350 E MCKELLIPS RD STE 2
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85203-2739
Practice Address - Country:US
Practice Address - Phone:623-462-8187
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-10-11
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLAC-21718101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health