Provider Demographics
NPI:1437571486
Name:TRUESDALE, TARA (LMFT)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:
Last Name:TRUESDALE
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:429 GUILFORD COLLEGE RD
Mailing Address - Street 2:APT. S
Mailing Address - City:GREENSBORO
Mailing Address - State:NC
Mailing Address - Zip Code:27409-2059
Mailing Address - Country:US
Mailing Address - Phone:336-577-0863
Mailing Address - Fax:
Practice Address - Street 1:213 E BESSEMER AVE
Practice Address - Street 2:
Practice Address - City:GREENSBORO
Practice Address - State:NC
Practice Address - Zip Code:27401-6324
Practice Address - Country:US
Practice Address - Phone:336-379-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-10
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NC1840106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist