Provider Demographics
NPI:1386267060
Name:HALL, TARA
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:280 LEVI JACKSON MILL RD STE A
Mailing Address - Street 2:
Mailing Address - City:LONDON
Mailing Address - State:KY
Mailing Address - Zip Code:40744-8325
Mailing Address - Country:US
Mailing Address - Phone:606-657-5504
Mailing Address - Fax:
Practice Address - Street 1:280 LEVI JACKSON MILL RD STE A
Practice Address - Street 2:
Practice Address - City:LONDON
Practice Address - State:KY
Practice Address - Zip Code:40744-8325
Practice Address - Country:US
Practice Address - Phone:606-657-5504
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-05-28
Last Update Date:2020-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health