Provider Demographics
NPI:1952660466
Name:WARD, TARA MARIE (BCABA)
Entity Type:Individual
Prefix:MISS
First Name:TARA
Middle Name:MARIE
Last Name:WARD
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1778
Mailing Address - Street 2:
Mailing Address - City:LEXINGTON
Mailing Address - State:KY
Mailing Address - Zip Code:40588-1778
Mailing Address - Country:US
Mailing Address - Phone:859-608-6368
Mailing Address - Fax:
Practice Address - Street 1:128 FAIRLAWN AVE
Practice Address - Street 2:
Practice Address - City:LEXINGTON
Practice Address - State:KY
Practice Address - Zip Code:40505-3224
Practice Address - Country:US
Practice Address - Phone:859-608-6368
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-04
Last Update Date:2012-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0-11-4234103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst