| Tara Wharem Lcsw Llc | |
|
8775 Regal Mist Ct Las Cruces NM 88011-9631 | |
| (575) 222-1650 | |
| (505) 672-7769 |
| Full Name | Tara Wharem Lcsw Llc |
|---|---|
| Speciality | Social Worker |
| Location | 8775 Regal Mist Ct, Las Cruces, New Mexico |
| Authorized Official Name and Position | Tara Wharem (OWNER) |
| Authorized Official Contact | 5752221650 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Tara Wharem Lcsw Llc Po Box 45681 Rio Rancho NM 87174-5681 Ph: (505) 226-1960 | Tara Wharem Lcsw Llc 8775 Regal Mist Ct Las Cruces NM 88011-9631 Ph: (575) 222-1650 |
| NPI Number | 1538814009 |
|---|---|
| Provider Enumeration Date | 02/14/2022 |
| Last Update Date | 02/14/2022 |
| Certification Date | 02/14/2022 |
| Medicare PECOS PAC ID | 9931569753 |
|---|---|
| Medicare Enrollment ID | O20230712001578 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1538814009 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tara Wharem |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1457970741 PECOS PAC ID: 1759741572 Enrollment ID: I20230713000176 |
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