Provider Demographics
NPI:1225275035
Name:FLECK, TARA L (LMLP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:FLECK
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2711 S ROUSE ST STE C&D
Mailing Address - Street 2:
Mailing Address - City:PITTSBURG
Mailing Address - State:KS
Mailing Address - Zip Code:66762-6620
Mailing Address - Country:US
Mailing Address - Phone:620-231-1068
Mailing Address - Fax:620-231-2792
Practice Address - Street 1:2711 S ROUSE ST STE C&D
Practice Address - Street 2:
Practice Address - City:PITTSBURG
Practice Address - State:KS
Practice Address - Zip Code:66762-6620
Practice Address - Country:US
Practice Address - Phone:620-231-1068
Practice Address - Fax:620-231-2792
Is Sole Proprietor?:No
Enumeration Date:2009-01-15
Last Update Date:2020-06-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1242101YM0800X
KS1303103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health