Provider Demographics
NPI:1700015583
Name:LINSLEY, TARA (LMHC, MCAP, CIP)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:LINSLEY
Suffix:
Gender:F
Credentials:LMHC, MCAP, CIP
Other - Prefix:MRS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:CARTER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:208 BOOTH RD SUITE D
Mailing Address - Street 2:
Mailing Address - City:ORMOND BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32174
Mailing Address - Country:US
Mailing Address - Phone:386-245-8662
Mailing Address - Fax:
Practice Address - Street 1:208 BOOTH RD, SUITE D
Practice Address - Street 2:
Practice Address - City:ORMOND BEACH
Practice Address - State:FL
Practice Address - Zip Code:32174
Practice Address - Country:US
Practice Address - Phone:386-245-8662
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-14
Last Update Date:2021-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
GALPC005631101YP2500X, 101YP2500X
FLMH12101101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional