Provider Demographics
NPI:1790239564
Name:HESTAND, TARA (PSYD; MHP)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HESTAND
Suffix:
Gender:F
Credentials:PSYD; MHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1316 SOMERVILLE RD SE STE 1
Mailing Address - Street 2:
Mailing Address - City:DECATUR
Mailing Address - State:AL
Mailing Address - Zip Code:35601-4309
Mailing Address - Country:US
Mailing Address - Phone:256-260-7361
Mailing Address - Fax:256-355-6092
Practice Address - Street 1:1307 E ELM ST
Practice Address - Street 2:
Practice Address - City:ATHENS
Practice Address - State:AL
Practice Address - Zip Code:35611
Practice Address - Country:US
Practice Address - Phone:256-232-3661
Practice Address - Fax:256-355-6092
Is Sole Proprietor?:No
Enumeration Date:2016-08-10
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL330000014Medicaid