MEDICARE: TARA STARK PSY.D.

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	103T00000X	Psychologist	021661	NY
2	103TC0700X	Clinical Psychologist	39172	TX
3	103T00000X	Psychologist	PSY.0006305	CO
4	103T00000X	Psychologist	39172	TX
5	103T00000X	Psychologist	PY10427	FL

General Provider Information

NPI Number	:	1811547599
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA STARK PSY.D.

Provider Business Mailing Address
First Line	:	5122 FLINT ROCK LN
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-8714
Country	:	US
Telephone Number	:	254-262-6626
Fax Number	:

Provider Business Practice Location Address
First Line	:	5122 FLINT ROCK LN
Second Line	:
City	:	TEMPLE
State	:	TX
Zip	:	76502-8714
Country	:	US
Telephone Number	:	254-262-6626
Fax Number	:

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

Provider Enumeration Date	:	09/16/2019
Last Update Date	:	09/16/2025

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Directions to “ TARA STARK PSY.D.” Practice Location

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