Provider Demographics
NPI:1215183280
Name:COLE, TARA M (PHD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:M
Last Name:COLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:515 ENTERPRISE DR STE 300
Mailing Address - Street 2:
Mailing Address - City:LOWELL
Mailing Address - State:AR
Mailing Address - Zip Code:72745-8982
Mailing Address - Country:US
Mailing Address - Phone:479-717-7626
Mailing Address - Fax:479-717-7627
Practice Address - Street 1:515 ENTERPRISE DR STE 300
Practice Address - Street 2:
Practice Address - City:LOWELL
Practice Address - State:AR
Practice Address - Zip Code:72745
Practice Address - Country:US
Practice Address - Phone:479-717-7626
Practice Address - Fax:479-717-7627
Is Sole Proprietor?:Yes
Enumeration Date:2008-08-11
Last Update Date:2019-01-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR08-17AP103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical