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General NPI Number Information
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NPI Number | 1659706117
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Entity Type | Individual
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Provider Name | TARA MICHELE DEWITT LCSW
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Gender | Female
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Dates
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Enumeration Date | 09/03/2013
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Last Update Date | 03/20/2024
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Provider Practice Location Address
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Address Line | 705 E OVERLAND
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City | SCOTTSBLUFF
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State | NE
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Zip | 69361-3602
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Country | US
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Telephone | 308-225-5330
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Fax |
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Provider Business Mailing Address
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Address Line | 360625 COUNTY ROAD K
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City | MINATARE
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State | NE
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Zip | 69356-2109
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Country | US
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Telephone | 308-672-3003
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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 | 1619
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License Number State | NE
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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 | 4704
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License Number State | NE
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