MEDICARE: DR. TARA VALINCHUS DEJOHN PHD, LCSW

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	1041C0700X	Clinical Social Worker	6610-C	AR

General Provider Information

NPI Number	:	1396483822
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. TARA VALINCHUS DEJOHN PHD, LCSW

Provider Business Mailing Address
First Line	:	420 W 4TH ST STE A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5393
Country	:	US
Telephone Number	:	501-408-3431
Fax Number	:

Provider Business Practice Location Address
First Line	:	420 W 4TH ST STE A
Second Line	:
City	:	NORTH LITTLE ROCK
State	:	AR
Zip	:	72114-5393
Country	:	US
Telephone Number	:	501-408-3431
Fax Number	:

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

Provider Enumeration Date	:	05/24/2022
Last Update Date	:	03/14/2026

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