MEDICARE: TARA KEEL 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	C014226	NC

General Provider Information

NPI Number	:	1093376691
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA KEEL LCSW

Provider Business Mailing Address
First Line	:	301 S MCDOWELL ST STE 125-1443
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2623
Country	:	US
Telephone Number	:	704-425-1273
Fax Number	:	704-275-9915

Provider Business Practice Location Address
First Line	:	301 S MCDOWELL ST STE 125-1443
Second Line	:
City	:	CHARLOTTE
State	:	NC
Zip	:	28204-2623
Country	:	US
Telephone Number	:	910-317-3456
Fax Number	:	704-275-9915

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

Provider Enumeration Date	:	06/25/2019
Last Update Date	:	01/12/2023

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