Provider Demographics
NPI:1265728265
Name:MULLINS, TARA ELIZABETH (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ELIZABETH
Last Name:MULLINS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:ELIZABETH
Other - Last Name:GREEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 3407
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47733-3407
Mailing Address - Country:US
Mailing Address - Phone:812-450-3363
Mailing Address - Fax:
Practice Address - Street 1:415 W COLUMBIA ST STE 110
Practice Address - Street 2:
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47710-1656
Practice Address - Country:US
Practice Address - Phone:812-450-3363
Practice Address - Fax:812-450-3071
Is Sole Proprietor?:No
Enumeration Date:2011-06-28
Last Update Date:2023-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY60821041C0700X
IN34010508A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical