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General NPI Number Information
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NPI Number | 1144998568
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Entity Type | Individual
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Provider Name | TARA GREENLEE LCSW
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Gender | Female
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Dates
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Enumeration Date | 08/31/2021
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Last Update Date | 01/07/2025
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Provider Practice Location Address
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Address Line | 105 S HULL ST
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City | FORT BRANCH
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State | IN
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Zip | 47648-1603
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Country | US
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Telephone | 812-403-3552
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Fax |
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Provider Business Mailing Address
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Address Line | 220 N 4TH ST
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City | ELBERFELD
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State | IN
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Zip | 47613-9282
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Country | US
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Telephone | 812-204-8273
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 34005949A
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License Number State | IN
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