Provider Demographics
NPI:1326194366
Name:FRANKLIN, TARA (MA)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:FRANKLIN
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 1:4530 WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:OMAHA
Mailing Address - State:NE
Mailing Address - Zip Code:68106-2528
Mailing Address - Country:US
Mailing Address - Phone:402-403-0707
Mailing Address - Fax:
Practice Address - Street 1:6002 WENNINGHOFF RD
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68134-1903
Practice Address - Country:US
Practice Address - Phone:402-403-0707
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-25
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE8219101YM0800X
CA47611106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist