Provider Demographics
NPI:1659706117
Name:DEWITT, TARA MICHELE (LCSW)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELE
Last Name:DEWITT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:MICHELE
Other - Last Name:ADAMSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMHP,MSW
Mailing Address - Street 1:360625 COUNTY ROAD K
Mailing Address - Street 2:
Mailing Address - City:MINATARE
Mailing Address - State:NE
Mailing Address - Zip Code:69356-2109
Mailing Address - Country:US
Mailing Address - Phone:308-672-3003
Mailing Address - Fax:
Practice Address - Street 1:705 E OVERLAND
Practice Address - Street 2:
Practice Address - City:SCOTTSBLUFF
Practice Address - State:NE
Practice Address - Zip Code:69361-3602
Practice Address - Country:US
Practice Address - Phone:308-225-5330
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE16191041C0700X
NE47041041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical