Provider Demographics
NPI:1871935411
Name:HASKELL, TARA MARSHELLE (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MARSHELLE
Last Name:HASKELL
Suffix:
Gender:
Credentials:LPC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MARSHELLE
Other - Last Name:SOBRIO
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:1114 NE REVERE AVE
Mailing Address - Street 2:
Mailing Address - City:BEND
Mailing Address - State:OR
Mailing Address - Zip Code:97701-4150
Mailing Address - Country:US
Mailing Address - Phone:541-788-8380
Mailing Address - Fax:
Practice Address - Street 1:1114 NE REVERE AVE
Practice Address - Street 2:
Practice Address - City:BEND
Practice Address - State:OR
Practice Address - Zip Code:97701-4150
Practice Address - Country:US
Practice Address - Phone:541-788-8380
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-07-24
Last Update Date:2025-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC4297101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health