Provider Demographics
NPI:1558915611
Name:SWEETEN, TARA (SPE, HSP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:SWEETEN
Suffix:
Gender:F
Credentials:SPE, HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:105 MUSIC VILLAGE BLVD
Mailing Address - Street 2:
Mailing Address - City:HENDERSONVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37075-2714
Mailing Address - Country:US
Mailing Address - Phone:615-824-3772
Mailing Address - Fax:615-447-1065
Practice Address - Street 1:105 MUSIC VILLAGE BLVD
Practice Address - Street 2:
Practice Address - City:HENDERSONVILLE
Practice Address - State:TN
Practice Address - Zip Code:37075-2714
Practice Address - Country:US
Practice Address - Phone:615-824-3772
Practice Address - Fax:615-447-1065
Is Sole Proprietor?:No
Enumeration Date:2019-07-27
Last Update Date:2019-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNPE11706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health