Healthcare Provider Details

I. General information

NPI: 1639998958
Provider Name (Legal Business Name): TARA L OSWALD LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/03/2024
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4287 LAFAYETTE ST
MARIANNA FL
32446-2919
US

IV. Provider business mailing address

2108 CROOMS RD
COTTONDALE FL
32431-7722
US

V. Phone/Fax

Practice location:
  • Phone: 850-209-3182
  • Fax:
Mailing address:
  • Phone: 850-209-3182
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH23915
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: