Tara Nicole Russell, MS, BCBA, LBA

Primary specialty

Behavior AnalystTaxonomy code 103K00000X

License

BEH-000896 Issued in AZ

Practice address

6550 E Broadway Rd Ste 110
Mesa, AZ 85206-1734

Phone

(480) 672-0772

Fax

(317) 520-8200

NPI assigned

Sep 17, 2008

Sex

Female

Sole proprietor

No

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

Specialties & licenses 2

Addresses

Other identifiers 1

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Science

State licenses

Practice roles

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

• Hopebridge LLC

  • Child & Adolescent Psychiatry Physician
  • Mesa, AZ
  • NPI 1730727645

  Behavior Analyst

  NPD (past)
• Trumpet Behavioral Health, LLC

  dba Trumpet Behavioral Health

  • Behavior Analyst
  • Gilbert, AZ
  • NPI 1699267153
  NPD (past)

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

{
    "created_epoch": "1221609600000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1682899200000",
    "number": "1649429465",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "7108 S KANNER HWY",
            "city": "STUART",
            "state": "FL",
            "postal_code": "349977462",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "6550 E BROADWAY RD STE 110",
            "city": "MESA",
            "state": "AZ",
            "postal_code": "852061734",
            "telephone_number": "480-672-0772",
            "fax_number": "317-520-8200"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "3100 W Ray Rd Ste 201",
            "address_purpose": "LOCATION",
            "city": "Chandler",
            "state": "AZ",
            "postal_code": "852262472",
            "country_code": "US",
            "telephone_number": "855-832-6727",
            "fax_number": "772-675-9100",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "RUSSELL",
        "first_name": "TARA",
        "middle_name": "NICOLE",
        "name_prefix": "Miss",
        "credential": "MS, BCBA, LBA",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2008-09-17",
        "last_updated": "2023-05-01",
        "certification_date": "2023-05-01",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "103K00000X",
            "taxonomy_group": "",
            "desc": "Behavior Analyst",
            "state": "AZ",
            "license": "BEH-000896",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BCBA CERTIFICATE",
            "identifier": "1-21-48060",
            "state": null
        }
    ],
    "endpoints": [],
    "other_names": []
}

• Helen Russell, CLINICAL LIAISON BHT
• Kevin Joseph Russell, O.D.
• Kristen Russell
• Sara Anne Russell, LPC
• Stuart Russell
• Antonio Joseph Russo
• Raechel Russo
• Melissa Jean Rutherford, MSN, APRN, FNP-C
• Chloe Desha Rutledge
• Kristine Lee Rutt, PNP

• Behavior Analyst in Mesa, AZ
• Providers in Mesa, AZ by specialty
• Behavior Analyst in Arizona

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on May 1, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.