Healthcare Provider Details

I. General information

NPI: 1174674501
Provider Name (Legal Business Name): TARA G THOMPSON PSYD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

Provider Other Name: TARA KATHLEEN GIDNEY PSYD

II. Dates (important events)

Enumeration Date: 01/14/2007
Last Update Date: 04/29/2026
Certification Date: 04/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5300 TOWN AND COUNTRY BLVD STE 240
FRISCO TX
75034-1008
US

IV. Provider business mailing address

2591 SE 15TH ST
POMPANO BEACH FL
33062-7504
US

V. Phone/Fax

Practice location:
  • Phone: 773-879-8272
  • Fax:
Mailing address:
  • Phone: 773-879-8272
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License NumberPY8628
License Number StateFL
# 2
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number71007131
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: