Healthcare Provider Details

I. General information

NPI: 1588297717
Provider Name (Legal Business Name): TARA N MUSE LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA N BUCHANAN LCSW

II. Dates (important events)

Enumeration Date: 02/17/2020
Last Update Date: 08/20/2025
Certification Date: 05/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

404 STEVE DR
RUSSELL SPRINGS KY
42642-4622
US

IV. Provider business mailing address

PO BOX 1080
BURKESVILLE KY
42717-1080
US

V. Phone/Fax

Practice location:
  • Phone: 270-866-3161
  • Fax: 270-866-3163
Mailing address:
  • Phone: 270-858-6655
  • Fax: 270-858-4027

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number254657
License Number StateKY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: