Provider Demographics
NPI:1346098100
Name:PHILPOT, TARA JANE (TCM, TCADC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:JANE
Last Name:PHILPOT
Suffix:
Gender:
Credentials:TCM, TCADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 PROGRESS DR
Mailing Address - Street 2:
Mailing Address - City:MOUNT VERNON
Mailing Address - State:KY
Mailing Address - Zip Code:40456-8590
Mailing Address - Country:US
Mailing Address - Phone:606-594-9018
Mailing Address - Fax:
Practice Address - Street 1:1700 FOREST DR
Practice Address - Street 2:
Practice Address - City:CORBIN
Practice Address - State:KY
Practice Address - Zip Code:40701-2316
Practice Address - Country:US
Practice Address - Phone:606-401-2075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-05-07
Last Update Date:2025-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY297913101YA0400X
KY1212765171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)