Provider Demographics
NPI:1558579953
Name:SPROULS, TARA ELIZABETH (MA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:SPROULS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:KITCHELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:214 N MAIN ST
Mailing Address - Street 2:
Mailing Address - City:GOODLETTSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37072-1516
Mailing Address - Country:US
Mailing Address - Phone:423-557-1983
Mailing Address - Fax:
Practice Address - Street 1:214 N MAIN ST
Practice Address - Street 2:
Practice Address - City:GOODLETTSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37072-1516
Practice Address - Country:US
Practice Address - Phone:423-557-1983
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-18
Last Update Date:2023-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN5434101YP2500X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty