Provider Demographics
NPI:1851709646
Name:DURHAM-HART, TARA (MED, MS, CVE)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:DURHAM-HART
Suffix:
Gender:F
Credentials:MED, MS, CVE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8815 CONROY WINDERMERE RD UNIT 241
Mailing Address - Street 2:
Mailing Address - City:ORLANDO
Mailing Address - State:FL
Mailing Address - Zip Code:32835-3129
Mailing Address - Country:US
Mailing Address - Phone:904-718-8855
Mailing Address - Fax:
Practice Address - Street 1:8815 CONROY WINDERMERE RD UNIT 241
Practice Address - Street 2:
Practice Address - City:ORLANDO
Practice Address - State:FL
Practice Address - Zip Code:32835-3129
Practice Address - Country:US
Practice Address - Phone:904-718-8855
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-24
Last Update Date:2016-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL596383Medicaid