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General NPI Number Information
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NPI Number | 1700191475
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Entity Type | Individual
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Provider Name | TARA LOUISE MCNAMARA LMHC
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Gender | Female
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Dates
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Enumeration Date | 08/18/2010
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Last Update Date | 02/26/2021
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Provider Practice Location Address
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Address Line | 13500 SUTTON PARK DR S STE 702
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City | JACKSONVILLE
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State | FL
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Zip | 32224-5290
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Country | US
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Telephone | 904-460-7348
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Fax | 904-431-3564
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Provider Business Mailing Address
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Address Line | 63 GALLEON DR
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City | PONTE VEDRA
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State | FL
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Zip | 32081-0797
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Country | US
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Telephone | 904-859-0409
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Fax | 904-431-3564
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH6551
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License Number State | FL
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