Provider Demographics
NPI:1902265424
Name:RICKARD, TARA (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:RICKARD
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1538 MAPLEVALE RD
Mailing Address - Street 2:
Mailing Address - City:BROOKVILLE
Mailing Address - State:PA
Mailing Address - Zip Code:15825-4810
Mailing Address - Country:US
Mailing Address - Phone:814-648-0233
Mailing Address - Fax:
Practice Address - Street 1:16 RICHARDS ST
Practice Address - Street 2:
Practice Address - City:BROOKVILLE
Practice Address - State:PA
Practice Address - Zip Code:15825
Practice Address - Country:US
Practice Address - Phone:814-648-0233
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-02-11
Last Update Date:2018-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC008756101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional