Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | 74850 | TX |
N | 101YP2500X | Professional Counselor | 74850 | TX |
NPI | 1003323437 |
---|---|
Provider Name | Dr. Tara Shanett Mukoro |
First Address | Sugar Land, TX 77479-1261 |
Second Address | Sugar Land, TX 77479-1261 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 08/01/2018 |
Last Update Date | 16/07/2021 |