Provider Demographics
NPI:1861133399
Name:HARVELL, TARA M (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:HARVELL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:M
Other - Last Name:ZIMMERMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:12633 N 50TH LN
Mailing Address - Street 2:
Mailing Address - City:GLENDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85304-2007
Mailing Address - Country:US
Mailing Address - Phone:602-423-4759
Mailing Address - Fax:
Practice Address - Street 1:12633 N 50TH LN
Practice Address - Street 2:
Practice Address - City:GLENDALE
Practice Address - State:AZ
Practice Address - Zip Code:85304-2007
Practice Address - Country:US
Practice Address - Phone:602-423-4759
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-06
Last Update Date:2023-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-21918101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZLAC-18254OtherAZ BOARD OF BEHAVIORAL HEALTH