Provider Demographics
NPI:1497042691
Name:TARA TOLAND INC.
Entity Type:Organization
Organization Name:TARA TOLAND INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:TOLAND
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:773-895-7609
Mailing Address - Street 1:4138 N RICHMOND ST
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60618-2614
Mailing Address - Country:US
Mailing Address - Phone:773-895-7609
Mailing Address - Fax:773-583-8480
Practice Address - Street 1:4138 N RICHMOND ST
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60618-2614
Practice Address - Country:US
Practice Address - Phone:773-895-7609
Practice Address - Fax:773-583-8480
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-07-08
Last Update Date:2011-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL1041C0700X251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health