Provider Demographics
NPI:1588895619
Name:SCHUCK, TARA (LMHC, NCSP)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:SCHUCK
Suffix:
Gender:F
Credentials:LMHC, NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N A ST
Mailing Address - Street 2:
Mailing Address - City:PENSACOLA
Mailing Address - State:FL
Mailing Address - Zip Code:32502-3605
Mailing Address - Country:US
Mailing Address - Phone:850-417-9279
Mailing Address - Fax:
Practice Address - Street 1:113 N PALAFOX ST
Practice Address - Street 2:
Practice Address - City:PENSACOLA
Practice Address - State:FL
Practice Address - Zip Code:32502-4838
Practice Address - Country:US
Practice Address - Phone:850-417-9279
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-06
Last Update Date:2010-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH8518101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health