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General NPI Number Information
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NPI Number | 1619307204
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Entity Type | Organization
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Legal Business Name | TARA M. COLE, PH.D., P.A.
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 3214 NW AVIGNON WAY SUITE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-3916
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Country | US
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Telephone | 479-271-8778
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Fax | 888-207-6093
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Provider Business Mailing Address
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Address Line | 3214 NW AVIGNON WAY SUITE 2
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City | BENTONVILLE
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State | AR
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Zip | 72712-3916
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Country | US
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Telephone | 479-271-8778
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Fax | 888-207-6093
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Authorized Official
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Title or Position | PRESIDENT
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Name | TARA M COLE
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Credential | PH.D.
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Telephone | 479-271-8778
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 09-14P
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License Number State | AR
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