Healthcare Provider Details

I. General information

NPI: 1700944493
Provider Name (Legal Business Name): TARA PAIGE BJORKMAN LMHC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/05/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6245 STATE ROAD 54
NEW PORT RICHEY FL
34653-6006
US

IV. Provider business mailing address

6245 STATE ROAD 54
NEW PORT RICHEY FL
34653-6006
US

V. Phone/Fax

Practice location:
  • Phone: 727-846-9496
  • Fax: 727-849-8410
Mailing address:
  • Phone: 727-846-9496
  • Fax: 727-849-8410

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH642
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: