Provider Demographics
NPI:1710385695
Name:FREM, TARA (PSYD)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FREM
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7984 NEW LA GRANGE RD
Mailing Address - Street 2:
Mailing Address - City:LOUISVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:40222-4718
Mailing Address - Country:US
Mailing Address - Phone:502-426-2777
Mailing Address - Fax:502-426-2776
Practice Address - Street 1:7984 NEW LA GRANGE RD
Practice Address - Street 2:
Practice Address - City:LOUISVILLE
Practice Address - State:KY
Practice Address - Zip Code:40222-4718
Practice Address - Country:US
Practice Address - Phone:502-426-2777
Practice Address - Fax:502-426-2776
Is Sole Proprietor?:No
Enumeration Date:2014-12-09
Last Update Date:2022-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY242845103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical