MEDICARE: MRS. TARA MARIE WATKINS MA, LPC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor	PC006468	PA

General Provider Information

NPI Number	:	1144574013
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. TARA MARIE WATKINS MA, LPC

Provider Business Mailing Address
First Line	:	231 NORTHERN BLVD STE A
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-766-9970
Fax Number	:

Provider Business Practice Location Address
First Line	:	231 NORTHERN BLVD STE A
Second Line	:
City	:	CLARKS SUMMIT
State	:	PA
Zip	:	18411-9189
Country	:	US
Telephone Number	:	570-766-9970
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/31/2012
Last Update Date	:	01/02/2025

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