Healthcare Provider Details

I. General information

NPI: 1427090380
Provider Name (Legal Business Name): TARA MICHELLE PARKHURST LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: TARA MICHELLE BROWN PARKHURST LCSW

II. Dates (important events)

Enumeration Date: 06/12/2006
Last Update Date: 08/25/2025
Certification Date: 08/25/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

121 E BROADWAY BLVD STE 107
SEDALIA MO
65301-5800
US

IV. Provider business mailing address

20250 SADIE LN
SEDALIA MO
65301-1515
US

V. Phone/Fax

Practice location:
  • Phone: 573-268-4419
  • Fax:
Mailing address:
  • Phone: 573-268-4419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2004033738
License Number StateMO

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: