Provider Demographics
NPI:1003186735
Name:FORRESTER, TARA JEAN (MS PLPC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:JEAN
Last Name:FORRESTER
Suffix:
Gender:F
Credentials:MS PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1002 S CRUTCHER AVE
Mailing Address - Street 2:
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0306
Mailing Address - Country:US
Mailing Address - Phone:417-848-0185
Mailing Address - Fax:
Practice Address - Street 1:6007 N 21ST ST
Practice Address - Street 2:
Practice Address - City:OZARK
Practice Address - State:MO
Practice Address - Zip Code:65721-7634
Practice Address - Country:US
Practice Address - Phone:417-581-6911
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-11
Last Update Date:2012-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2011036258101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional