MEDICARE: TARA TOLAND INC.

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	251S00000X	Community/Behavioral Health Agency	1041C0700X	IL

General Provider Information

NPI Number	:	1497042691
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA TOLAND INC.

Provider Business Mailing Address
First Line	:	4138 N RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2614
Country	:	US
Telephone Number	:	773-895-7609
Fax Number	:	773-583-8480

Provider Business Practice Location Address
First Line	:	4138 N RICHMOND ST
Second Line	:
City	:	CHICAGO
State	:	IL
Zip	:	60618-2614
Country	:	US
Telephone Number	:	773-895-7609
Fax Number	:	773-583-8480

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MS. TARA TOLAND
Credential	:	LCSW
Telephone Number	:	773-895-7609

Provider Enumeration Date	:	07/08/2011
Last Update Date	:	07/08/2011

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