Healthcare Provider Details

I. General information

NPI: 1194223396
Provider Name (Legal Business Name): TARA MUHAMMAD CDCA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/23/2018
Last Update Date: 08/20/2025
Certification Date: 08/20/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1948 N LIMESTONE ST
SPRINGFIELD OH
45503-2648
US

IV. Provider business mailing address

22 N DOUGLAS AVE
SPRINGFIELD OH
45503-4940
US

V. Phone/Fax

Practice location:
  • Phone: 866-534-2639
  • Fax: 800-480-7578
Mailing address:
  • Phone: 937-244-3076
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberCDCA.140800
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: