Provider Demographics
NPI:1568695567
Name:FARMER, TARA (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FARMER
Suffix:
Gender:F
Credentials:LPC
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 601
Mailing Address - Street 2:
Mailing Address - City:ONALASKA
Mailing Address - State:WI
Mailing Address - Zip Code:54650-0601
Mailing Address - Country:US
Mailing Address - Phone:608-668-4848
Mailing Address - Fax:
Practice Address - Street 1:N5689 SUNSET DR
Practice Address - Street 2:
Practice Address - City:ONALASKA
Practice Address - State:WI
Practice Address - Zip Code:54650-9453
Practice Address - Country:US
Practice Address - Phone:608-668-4848
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-25
Last Update Date:2021-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4640-125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI674-226OtherPROFESSIONAL TRAINING LICENSE