Provider Demographics
NPI:1427631365
Name:TARR, AUBREY (LPC)
Entity type:Individual
Prefix:
First Name:AUBREY
Middle Name:
Last Name:TARR
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11150 SULPHUR SPRINGS RD
Mailing Address - Street 2:
Mailing Address - City:LOAMI
Mailing Address - State:IL
Mailing Address - Zip Code:62661-3159
Mailing Address - Country:US
Mailing Address - Phone:217-691-4493
Mailing Address - Fax:
Practice Address - Street 1:2200 S 6TH ST
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:IL
Practice Address - Zip Code:62703-3454
Practice Address - Country:US
Practice Address - Phone:217-698-7150
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-29
Last Update Date:2021-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178014895101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional