Tara Pettit Deloach LLC

Primary specialty

Adult Mental Health Clinic/CenterTaxonomy code 261QM0850X

Legal business name

TARA PETTIT DELOACH LLC

Practice address

930 Stevens Creek Rd
Augusta, GA 30907-3200

Phone

(706) 343-3661

NPI assigned

Jan 2, 2024

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Tara Pettit Deloach, LMFT

Title

Owner

Phone

(706) 343-3661

Specialties & licenses 1

Addresses

Medicare fee-for-service enrollment

Enrolled in GA

Enrollment records 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1704153600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1704153600000",
    "number": "1124897145",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "930 STEVENS CREEK RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309073200",
            "telephone_number": "706-343-3661"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "930 STEVENS CREEK RD",
            "city": "AUGUSTA",
            "state": "GA",
            "postal_code": "309073200",
            "telephone_number": "706-343-3661"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "TARA PETTIT DELOACH LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2024-01-02",
        "last_updated": "2024-01-02",
        "certification_date": "2024-01-02",
        "status": "A",
        "authorized_official_last_name": "DELOACH",
        "authorized_official_first_name": "TARA",
        "authorized_official_middle_name": "PETTIT",
        "authorized_official_title_or_position": "OWNER",
        "authorized_official_telephone_number": "706-343-3661",
        "authorized_official_credential": "LMFT"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Kailyn Tanksley
• Precious Tanksley, PTA
• William Bruce Tannehill, M.D.
• Tommy Tanner, COTA
• Brandon Tapasak, MD
• Daler E Tarrazzi, DDS, MS
• Barbara Ann Tarver, NP-C
• Varsha S Taskar, MD
• Lashunda Tate, APRN
• Aniket Ashok Tatugade, M.B.B.S

• Adult Mental Health Clinic/Center in Augusta, GA
• Providers in Augusta, GA by specialty
• Adult Mental Health Clinic/Center in Georgia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 2, 2024; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• Medicare enrollment (CMS PECOS): enrollments, PAC IDs and benefit reassignments.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.