MEDICARE: TARA L WOOD LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker	4159	TN

General Provider Information

NPI Number	:	1003087834
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA L WOOD LCSW

Provider Business Mailing Address
First Line	:	PO BOX 11085
Second Line	:
City	:	CHATTANOOGA
State	:	TN
Zip	:	37401-2085
Country	:	US
Telephone Number	:	423-778-3274
Fax Number	:	423-778-2255

Provider Business Practice Location Address
First Line	:	632 MORRISON SPRINGS RD
Second Line	:	SUITE 202
City	:	CHATTANOOGA
State	:	TN
Zip	:	37415-3402
Country	:	US
Telephone Number	:	423-778-5945
Fax Number	:	423-778-3551

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	03/19/2008
Last Update Date	:	03/19/2008

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