Provider Demographics
NPI:1174961635
Name:BLEAKLEY, TARA E (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:E
Last Name:BLEAKLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:E
Other - Last Name:LEMON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:100 INNWOOD DR STE A
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70433-9255
Mailing Address - Country:US
Mailing Address - Phone:985-400-9552
Mailing Address - Fax:
Practice Address - Street 1:100 INNWOOD DR STE A
Practice Address - Street 2:
Practice Address - City:COVINGTON
Practice Address - State:LA
Practice Address - Zip Code:70433-9255
Practice Address - Country:US
Practice Address - Phone:985-400-9552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-06
Last Update Date:2019-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA4706101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional