Provider Demographics
NPI:1881801108
Name:THOMPSON, TARA RENEE (BS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:RENEE
Last Name:THOMPSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:R
Other - Last Name:RAMSEY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS
Mailing Address - Street 1:508 W STOTLAR ST
Mailing Address - Street 2:
Mailing Address - City:WEST FRANKFORT
Mailing Address - State:IL
Mailing Address - Zip Code:62896-2546
Mailing Address - Country:US
Mailing Address - Phone:618-218-8875
Mailing Address - Fax:
Practice Address - Street 1:408 E VINE ST
Practice Address - Street 2:
Practice Address - City:VIENNA
Practice Address - State:IL
Practice Address - Zip Code:62995-1612
Practice Address - Country:US
Practice Address - Phone:618-658-2611
Practice Address - Fax:618-658-2501
Is Sole Proprietor?:No
Enumeration Date:2007-05-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health