Provider Demographics
NPI:1497422935
Name:HUMMEL, TARA JOI (MA, LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:JOI
Last Name:HUMMEL
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:360 S BALDERSTON DR
Mailing Address - Street 2:
Mailing Address - City:EXTON
Mailing Address - State:PA
Mailing Address - Zip Code:19341-2004
Mailing Address - Country:US
Mailing Address - Phone:678-395-1695
Mailing Address - Fax:
Practice Address - Street 1:360 S BALDERSTON DR
Practice Address - Street 2:
Practice Address - City:EXTON
Practice Address - State:PA
Practice Address - Zip Code:19341-2004
Practice Address - Country:US
Practice Address - Phone:678-395-1695
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-08-24
Last Update Date:2021-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012781101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional