Provider Demographics
NPI:1134835937
Name:SLAY, TARA S (ALC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:S
Last Name:SLAY
Suffix:
Gender:F
Credentials:ALC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:198 US HIGHWAY 278 E
Mailing Address - Street 2:
Mailing Address - City:CULLMAN
Mailing Address - State:AL
Mailing Address - Zip Code:35055-0690
Mailing Address - Country:US
Mailing Address - Phone:888-355-7080
Mailing Address - Fax:
Practice Address - Street 1:198 US HIGHWAY 278 E
Practice Address - Street 2:
Practice Address - City:CULLMAN
Practice Address - State:AL
Practice Address - Zip Code:35055-0690
Practice Address - Country:US
Practice Address - Phone:888-355-7080
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-01-25
Last Update Date:2023-01-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ALALC04376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AL235540Medicaid