Provider Demographics
NPI:1336442557
Name:HOLSTEIN, TARA NICOLE (PSYD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:NICOLE
Last Name:HOLSTEIN
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4104 EDEN AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37215-3520
Mailing Address - Country:US
Mailing Address - Phone:312-248-4243
Mailing Address - Fax:
Practice Address - Street 1:6555 UPTON LN
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37209-4319
Practice Address - Country:US
Practice Address - Phone:312-248-4243
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-09
Last Update Date:2024-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071008589103TC0700X
KS1740103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical