Provider Demographics
NPI:1982986667
Name:AYALA, TARA (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:AYALA
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4500 S LANCASTER RD
Mailing Address - Street 2:549 SWS
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75216-7167
Mailing Address - Country:US
Mailing Address - Phone:826-583-2360
Mailing Address - Fax:826-583-2360
Practice Address - Street 1:2306 LAKE AUSTIN BLVD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-4546
Practice Address - Country:US
Practice Address - Phone:512-200-2615
Practice Address - Fax:512-469-0515
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-19
Last Update Date:2025-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1041C0700X
TX515801041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical