Provider Demographics
NPI:1922342880
Name:BENNETT, TARA MORRIS (LPC)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:MORRIS
Last Name:BENNETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 MAGNOLIA ST
Mailing Address - Street 2:ROOM 201
Mailing Address - City:SPARTANBURG
Mailing Address - State:SC
Mailing Address - Zip Code:29306-2359
Mailing Address - Country:US
Mailing Address - Phone:864-562-4210
Mailing Address - Fax:
Practice Address - Street 1:180 MAGNOLIA ST
Practice Address - Street 2:ROOM 201
Practice Address - City:SPARTANBURG
Practice Address - State:SC
Practice Address - Zip Code:29306-2359
Practice Address - Country:US
Practice Address - Phone:864-562-4210
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-16
Last Update Date:2012-11-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC5350101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional