MEDICARE: TARA M WATKINS, MA, LPC, LLC

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	PC006468	PA

General Provider Information

NPI Number	:	1679903363
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	TARA M WATKINS, MA, LPC, LLC

Provider Business Mailing Address
First Line	:	211 SIMPSON ST
Second Line	:
City	:	EYNON
State	:	PA
Zip	:	18403-1219
Country	:	US
Telephone Number	:	570-766-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 NORTHERN BOULEVARD
Second Line	:	SUITE A
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-766-9970
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	TARA MARIE WATKINS
Credential	:	MA, LPC, LLC
Telephone Number	:	570-766-9970

Provider Enumeration Date	:	11/18/2013
Last Update Date	:	01/02/2025

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