Provider Demographics
NPI:1174076830
Name:ELLIOT, TARA (MA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:ELLIOT
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:237 W LANCASTER AVE
Mailing Address - Street 2:
Mailing Address - City:SHILLINGTON
Mailing Address - State:PA
Mailing Address - Zip Code:19607-1889
Mailing Address - Country:US
Mailing Address - Phone:610-780-5877
Mailing Address - Fax:844-512-6985
Practice Address - Street 1:154 SKYLINE DR
Practice Address - Street 2:
Practice Address - City:READING
Practice Address - State:PA
Practice Address - Zip Code:19606-8531
Practice Address - Country:US
Practice Address - Phone:610-780-5877
Practice Address - Fax:844-512-6985
Is Sole Proprietor?:Yes
Enumeration Date:2016-07-29
Last Update Date:2016-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health