Basic Information
| Provider Information | |||||||||
| NPI: | 1912453291 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | WHITNEY | ||||||||
| FirstName: | TARA | ||||||||
| MiddleName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 420 MAGNOLIA ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 703606304 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858793966 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 420 MAGNOLIA ST | ||||||||
| Address2: | |||||||||
| City: | HOUMA | ||||||||
| State: | LA | ||||||||
| PostalCode: | 70360 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9858793966 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/28/2016 | ||||||||
| LastUpdateDate: | 09/06/2022 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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| NPICertificationDate: | 09/06/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | LA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 101YM0800X | 8112 | LA | N | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Mental Health | 171M00000X | N | Other Service Providers | Case Manager/Care Coordinator | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.