Tarra Lynn Pannullo, MA, NCC

Primary specialty

Mental Health CounselorTaxonomy code 101YM0800X

License

IMH21446 Issued in FL

Practice address

9000 Sheridan St
Pembroke Pines, FL 33024-8802

Phone

(954) 440-6386

NPI assigned

Mar 3, 2015

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 names 1

• Tarra Lane Former name

Medicare fee-for-service enrollment

Not listed in the public Medicare enrollment file

Medicare enrollment (NPD)

Not enrolled

Credentials

Master of Arts

State licenses

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

{
    "created_epoch": "1425340800000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1660694400000",
    "number": "1679965438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1800 MERCY DR",
            "city": "ORLANDO",
            "state": "FL",
            "postal_code": "328085646",
            "telephone_number": "407-875-3700",
            "fax_number": "407-659-0411"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "9000 SHERIDAN ST",
            "city": "PEMBROKE PINES",
            "state": "FL",
            "postal_code": "330248802",
            "telephone_number": "954-440-6386"
        }
    ],
    "practiceLocations": [
        {
            "address_1": "1800 Mercy Dr",
            "address_purpose": "LOCATION",
            "city": "Orlando",
            "state": "FL",
            "postal_code": "328085646",
            "country_code": "US",
            "telephone_number": "407-875-3700",
            "fax_number": "407-659-0411",
            "country_name": "United States",
            "address_type": "DOM"
        }
    ],
    "basic": {
        "last_name": "PANNULLO",
        "first_name": "TARRA",
        "middle_name": "LYNN",
        "credential": "MA, NCC",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2015-03-03",
        "last_updated": "2022-08-17",
        "certification_date": "2022-08-03",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "171M00000X",
            "taxonomy_group": "",
            "desc": "Case Manager/Care Coordinator",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "101YM0800X",
            "taxonomy_group": "",
            "desc": "Counselor, Mental Health",
            "state": "FL",
            "license": "IMH21446",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARRA",
            "last_name": "LANE",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

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• Mental Health Counselor in Pembroke Pines, FL
• Providers in Pembroke Pines, FL by specialty
• Mental Health Counselor in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 17, 2022; 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.