Provider Demographics
NPI:1013502939
Name:FREEMAN, TARA (BCBA)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:FREEMAN
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:74244 AIRPORT RD
Mailing Address - Street 2:
Mailing Address - City:COVINGTON
Mailing Address - State:LA
Mailing Address - Zip Code:70435-5660
Mailing Address - Country:US
Mailing Address - Phone:732-379-8846
Mailing Address - Fax:
Practice Address - Street 1:800 JACKSON AVE
Practice Address - Street 2:
Practice Address - City:MANDEVILLE
Practice Address - State:LA
Practice Address - Zip Code:70448-5328
Practice Address - Country:US
Practice Address - Phone:504-451-2543
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1-21-47980103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst