Provider Demographics
NPI:1245830991
Name:TARA MITCHELL, LCSW
Entity type:Organization
Organization Name:TARA MITCHELL, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER
Authorized Official - Prefix:
Authorized Official - First Name:TARA
Authorized Official - Middle Name:
Authorized Official - Last Name:MITCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:817-645-3328
Mailing Address - Street 1:2250 HOPEWELL RD
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76031-0384
Mailing Address - Country:US
Mailing Address - Phone:757-581-3646
Mailing Address - Fax:
Practice Address - Street 1:904 N MAIN ST STE C
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3803
Practice Address - Country:US
Practice Address - Phone:817-645-3328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-30
Last Update Date:2022-06-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty