Provider Demographics
NPI:1679903363
Name:TARA M WATKINS, MA, LPC, LLC
Entity Type:Organization
Organization Name:TARA M WATKINS, MA, LPC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:WALKER
Authorized Official - Suffix:
Authorized Official - Credentials:MA-ATR, LPC, LLC
Authorized Official - Phone:570-766-9970
Mailing Address - Street 1:211 SIMPSON ST
Mailing Address - Street 2:
Mailing Address - City:EYNON
Mailing Address - State:PA
Mailing Address - Zip Code:18403-1219
Mailing Address - Country:US
Mailing Address - Phone:570-766-9970
Mailing Address - Fax:
Practice Address - Street 1:231 NORTHERN BOULEVARD
Practice Address - Street 2:SUITE A
Practice Address - City:CLARKS SUMMIT
Practice Address - State:PA
Practice Address - Zip Code:18411-9189
Practice Address - Country:US
Practice Address - Phone:570-766-9970
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2024-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC006468251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health