MEDICARE: TARA LOUISE MCNAMARA LMHC

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	101YM0800X	Mental Health Counselor	MH6551	FL

General Provider Information

NPI Number	:	1700191475
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	TARA LOUISE MCNAMARA LMHC

Provider Business Mailing Address
First Line	:	63 GALLEON DR
Second Line	:
City	:	PONTE VEDRA
State	:	FL
Zip	:	32081-0797
Country	:	US
Telephone Number	:	904-859-0409
Fax Number	:	904-431-3564

Provider Business Practice Location Address
First Line	:	13500 SUTTON PARK DR S STE 702
Second Line	:
City	:	JACKSONVILLE
State	:	FL
Zip	:	32224-5290
Country	:	US
Telephone Number	:	904-460-7348
Fax Number	:	904-431-3564

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

Provider Enumeration Date	:	08/18/2010
Last Update Date	:	02/26/2021

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