Individual
TARA PORTUGAIS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMSW
Contact information
Practice address
1792 E GRAND CANYON DR, MERIDIAN, ID 83646-5245
(925) 548-9984
Mailing address
1792 E GRAND CANYON DR, MERIDIAN, ID 83646-5245
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
7871975
ID
104100000X
Social Worker
Primary
7871975
ID
Other
Enumeration date
08/13/2025
Last updated
04/06/2026
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