Provider Demographics
NPI:1205394236
Name:HARVILL, TARA LEE (LMHC, LMFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:LEE
Last Name:HARVILL
Suffix:
Gender:F
Credentials:LMHC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2180 N PARK AVE STE 328
Mailing Address - Street 2:
Mailing Address - City:WINTER PARK
Mailing Address - State:FL
Mailing Address - Zip Code:32789-2358
Mailing Address - Country:US
Mailing Address - Phone:407-719-2758
Mailing Address - Fax:407-629-6447
Practice Address - Street 1:2180 N PARK AVE STE 328
Practice Address - Street 2:
Practice Address - City:WINTER PARK
Practice Address - State:FL
Practice Address - Zip Code:32789-2358
Practice Address - Country:US
Practice Address - Phone:407-719-2758
Practice Address - Fax:407-629-6447
Is Sole Proprietor?:Yes
Enumeration Date:2019-03-08
Last Update Date:2019-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT2610106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist