Provider Demographics
NPI:1801660162
Name:PODJENSKI, TARA (LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:PODJENSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1007 THE SHORES DR
Mailing Address - Street 2:
Mailing Address - City:CORSICANA
Mailing Address - State:TX
Mailing Address - Zip Code:75109-3502
Mailing Address - Country:US
Mailing Address - Phone:903-879-2025
Mailing Address - Fax:
Practice Address - Street 1:1007 THE SHORES DR
Practice Address - Street 2:
Practice Address - City:CORSICANA
Practice Address - State:TX
Practice Address - Zip Code:75109-3502
Practice Address - Country:US
Practice Address - Phone:903-879-2025
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-11-08
Last Update Date:2023-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX87267101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional