Provider Demographics
NPI:1174821268
Name:CONCELMAN, TARA HULSE (BCBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:HULSE
Last Name:CONCELMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10 N SUMMERLIN AVE
Mailing Address - Street 2:#16
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32801-2967
Mailing Address - Country:US
Mailing Address - Phone:407-451-7607
Mailing Address - Fax:
Practice Address - Street 1:815 N MAGNOLIA AVE
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32803-3810
Practice Address - Country:US
Practice Address - Phone:407-451-7607
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-14
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst