Provider Demographics
NPI:1982225157
Name:DORMAN, TARA DENISE (PLPC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:DENISE
Last Name:DORMAN
Suffix:
Gender:F
Credentials:PLPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:323 MAIN STREET
Mailing Address - Street 2:PO BOX 83
Mailing Address - City:NORTONVILLE
Mailing Address - State:KS
Mailing Address - Zip Code:66060
Mailing Address - Country:US
Mailing Address - Phone:573-424-0292
Mailing Address - Fax:
Practice Address - Street 1:724 N 22ND ST
Practice Address - Street 2:
Practice Address - City:SAINT JOSEPH
Practice Address - State:MO
Practice Address - Zip Code:64506-2604
Practice Address - Country:US
Practice Address - Phone:816-364-1501
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-04-29
Last Update Date:2020-04-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2019006598101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health