Provider Demographics
NPI:1639998958
Name:OSWALD, TARA L (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:L
Last Name:OSWALD
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2108 CROOMS RD
Mailing Address - Street 2:
Mailing Address - City:COTTONDALE
Mailing Address - State:FL
Mailing Address - Zip Code:32431-7722
Mailing Address - Country:US
Mailing Address - Phone:850-209-3182
Mailing Address - Fax:
Practice Address - Street 1:2108 CROOMS RD
Practice Address - Street 2:
Practice Address - City:COTTONDALE
Practice Address - State:FL
Practice Address - Zip Code:32431-7722
Practice Address - Country:US
Practice Address - Phone:850-209-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH23915101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health