=====================================================
General NPI Number Information
=====================================================
NPI Number | 1780479626
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | STARK PSYCHOLOGY SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/11/2025
-----------------------------------------------------
Last Update Date | 01/27/2026
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 5122 FLINT ROCK LN
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-8714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-262-2262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5122 FLINT ROCK LN
-----------------------------------------------------
City | TEMPLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76502-8714
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 254-262-2262
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/CLINICAL PSYCHOLOGIST
-----------------------------------------------------
Name | DR. TARA STARK
-----------------------------------------------------
Credential | PSY.D.
-----------------------------------------------------
Telephone | 254-262-6626
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------