Provider Demographics
NPI:1952000697
Name:WILLIAMS, TARA NICOLE (PCLC)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:NICOLE
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:PCLC
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:NICOLE
Other - Last Name:HIGGINS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3452 BEAVERHEAD ST
Mailing Address - Street 2:
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59718-6216
Mailing Address - Country:US
Mailing Address - Phone:406-224-0847
Mailing Address - Fax:
Practice Address - Street 1:1174 STONERIDGE DR STE 207
Practice Address - Street 2:
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59718-9850
Practice Address - Country:US
Practice Address - Phone:406-224-3071
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-02
Last Update Date:2023-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health