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General NPI Number Information
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NPI Number | 1639379407
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Entity Type | Individual
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Provider Name | TARA GULLING HAVELY LCSW
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Gender | Female
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Dates
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Enumeration Date | 07/20/2007
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Last Update Date | 09/06/2023
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Provider Practice Location Address
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Address Line | 705 GATE LN STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37909-3519
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Country | US
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Telephone | 865-444-8580
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Fax |
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Provider Business Mailing Address
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Address Line | 705 GATE LN STE 102
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City | KNOXVILLE
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State | TN
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Zip | 37909-3519
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Country | US
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Telephone | 865-444-8580
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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 | 7277
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License Number State | TN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | LSW5265
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License Number State | TN
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Taxonomy #3
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5265
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License Number State | TN
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Taxonomy #4
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State | TN
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Taxonomy #5
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | CSW7277
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License Number State | TN
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