Provider Demographics
NPI:1134661515
Name:BEARDSLEY, TARA ANN
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:BEARDSLEY
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 1:6 DAYTON RD
Mailing Address - Street 2:
Mailing Address - City:ASHEVILLE
Mailing Address - State:NC
Mailing Address - Zip Code:28804-3311
Mailing Address - Country:US
Mailing Address - Phone:828-772-4231
Mailing Address - Fax:828-298-4870
Practice Address - Street 1:6 DAYTON RD
Practice Address - Street 2:
Practice Address - City:ASHEVILLE
Practice Address - State:NC
Practice Address - Zip Code:28804-3311
Practice Address - Country:US
Practice Address - Phone:828-772-4231
Practice Address - Fax:828-298-4870
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-16
Last Update Date:2016-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NCA12264101YM0800X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional