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General NPI Number Information
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NPI Number | 1659805844
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Entity Type | Individual
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Provider Name | TARA LE DAVIS
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Gender | Female
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Dates
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Enumeration Date | 04/14/2017
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Last Update Date | 10/15/2025
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Provider Practice Location Address
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Address Line | 685 SHELBY TRL STE 105
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City | CONWAY
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State | AR
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Zip | 72034-7169
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Country | US
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Telephone | 501-406-2232
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Fax | 870-933-9395
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Provider Business Mailing Address
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Address Line | 1700 CALDWELL ST APT 9
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City | CONWAY
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State | AR
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Zip | 72034-5260
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Country | US
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Telephone | 501-499-9186
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | P2008064
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License Number State | AR
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