Healthcare Provider Details

I. General information

NPI: 1497738165
Provider Name (Legal Business Name): TARA SLOAN JUNGERSEN PH.D., LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 05/28/2026
Certification Date: 05/28/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

PO BOX 22697
FORT LAUDERDALE FL
33335-2697
US

IV. Provider business mailing address

PO BOX 22697
FORT LAUDERDALE FL
33335-2697
US

V. Phone/Fax

Practice location:
  • Phone: 954-262-5764
  • Fax:
Mailing address:
  • Phone: 954-262-5764
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH10427
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: