Provider Demographics
NPI:1497738165
Name:JUNGERSEN, TARA SLOAN (MED, LPC-MHSP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:SLOAN
Last Name:JUNGERSEN
Suffix:
Gender:F
Credentials:MED, LPC-MHSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 21561
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37424-0561
Mailing Address - Country:US
Mailing Address - Phone:423-667-1678
Mailing Address - Fax:
Practice Address - Street 1:5916 BRAINERD RD
Practice Address - Street 2:SUITE 107
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-3524
Practice Address - Country:US
Practice Address - Phone:423-667-1678
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-11-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1701101YP2500X
AZ10137101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional