Provider Demographics
NPI:1386522977
Name:HELOU, TARA JANE
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:JANE
Last Name:HELOU
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6718 PALO VERDE PL
Mailing Address - Street 2:
Mailing Address - City:RANCHO CUCAMONGA
Mailing Address - State:CA
Mailing Address - Zip Code:91739-1547
Mailing Address - Country:US
Mailing Address - Phone:909-851-8390
Mailing Address - Fax:
Practice Address - Street 1:1074 PARK VIEW DR STE 102
Practice Address - Street 2:
Practice Address - City:COVINA
Practice Address - State:CA
Practice Address - Zip Code:91724-3749
Practice Address - Country:US
Practice Address - Phone:626-331-8177
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-08-22
Last Update Date:2025-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA156952106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist