Healthcare Provider Details

I. General information

NPI: 1497738165
Provider Name (Legal Business Name): TARA SLOAN JUNGERSEN M.ED., LPC-MHSP
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/26/2005
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5916 BRAINERD RD SUITE 107
CHATTANOOGA TN
37421-3524
US

IV. Provider business mailing address

PO BOX 21561
CHATTANOOGA TN
37424-0561
US

V. Phone/Fax

Practice location:
  • Phone: 423-667-1678
  • Fax:
Mailing address:
  • Phone: 423-667-1678
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1701
License Number StateTN
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number10137
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: