Provider Demographics
NPI:1639379407
Name:HAVELY, TARA GULLING (LCSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:GULLING
Last Name:HAVELY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:LYNN
Other - Last Name:GULLING
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LCSW
Mailing Address - Street 1:705 GATE LN STE 102
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37909-3519
Mailing Address - Country:US
Mailing Address - Phone:865-444-8580
Mailing Address - Fax:
Practice Address - Street 1:705 GATE LN STE 102
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37909-3519
Practice Address - Country:US
Practice Address - Phone:865-444-8580
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-07-20
Last Update Date:2023-09-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN72771041C0700X
TNLSW52651041C0700X
TN52651041C0700X
TN1041C0700X
TNCSW72771041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical