Healthcare Provider Details

I. General information

NPI: 1417768839
Provider Name (Legal Business Name): TARA HOBBS MRC, LPCC-S
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2025
Last Update Date: 02/04/2025
Certification Date: 02/04/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3248 WARSAW ST
TOLEDO OH
43608-1852
US

IV. Provider business mailing address

1699 HENTHORNE DR
MAUMEE OH
43537-1300
US

V. Phone/Fax

Practice location:
  • Phone: 419-244-9900
  • Fax:
Mailing address:
  • Phone: 419-346-9816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberE.0002907-SUPV
License Number StateOH

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: