Provider Demographics
NPI:1619307204
Name:TARA M. COLE, PH.D., P.A.
Entity Type:Organization
Organization Name:TARA M. COLE, PH.D., P.A.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:M
Authorized Official - Last Name:COLE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:479-271-8778
Mailing Address - Street 1:3214 NW AVIGNON WAY
Mailing Address - Street 2:SUITE 2
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72712-3916
Mailing Address - Country:US
Mailing Address - Phone:479-271-8778
Mailing Address - Fax:888-207-6093
Practice Address - Street 1:3214 NW AVIGNON WAY
Practice Address - Street 2:SUITE 2
Practice Address - City:BENTONVILLE
Practice Address - State:AR
Practice Address - Zip Code:72712-3916
Practice Address - Country:US
Practice Address - Phone:479-271-8778
Practice Address - Fax:888-207-6093
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR09-14P103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty