Healthcare Provider Details

I. General information

NPI: 1902096654
Provider Name (Legal Business Name): TARA MARIE HUBER MSE, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA MARIE YARBROUGH MSE, LPC

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 09/30/2026
Certification Date: 09/30/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 MEDICAL DR
HANNIBAL MO
63401-6877
US

IV. Provider business mailing address

1005 BROADWAY ST
QUINCY IL
62301-2834
US

V. Phone/Fax

Practice location:
  • Phone: 573-221-5250
  • Fax: 573-231-3823
Mailing address:
  • Phone: 217-223-8400
  • Fax: 217-277-3960

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberTPMC8385
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number106355
License Number StateIA
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6881129
License Number StateID
# 4
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2007021204
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: