Individual
TARA COSTA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LAMFT
Contact information
Practice address
3127 W LONE CACTUS DR, PHOENIX, AZ 85027
(602) 826-6991
Mailing address
3127 W LONE CACTUS DR, PHOENIX, AZ 85027
(602) 826-6991
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
10736
AZ
Other
Enumeration date
09/02/2022
Last updated
09/02/2022
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