Provider Demographics
NPI:1124571781
Name:MOORE, TARA LEIGH (LGSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEIGH
Last Name:MOORE
Suffix:
Gender:F
Credentials:LGSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LEIGH
Other - Last Name:SPREWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LGSW
Mailing Address - Street 1:420 28TH AVE
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TUSCALOOSA
Mailing Address - State:AL
Mailing Address - Zip Code:35401-1088
Mailing Address - Country:US
Mailing Address - Phone:205-737-3720
Mailing Address - Fax:
Practice Address - Street 1:420 28TH AVE
Practice Address - Street 2:SUITE 200
Practice Address - City:TUSCALOOSA
Practice Address - State:AL
Practice Address - Zip Code:35401-1088
Practice Address - Country:US
Practice Address - Phone:205-737-3720
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-08-01
Last Update Date:2016-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AL3430-G104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker