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NPI Code Detail

MEDICARE: TARA VALENTINE

MEDICARE: TARA VALENTINE
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
1101Y00000XCounselor180.016423IL
2101YP2500XProfessional Counselor180.016423IL

General Provider Information

NPI Number : 1972115988
Entity Type Code : Individual
Provider Name (Legal Business Name) : TARA VALENTINE
Provider Business Mailing Address
First Line : 2206 EASTLAND DR STE 101
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-7742
Country : US
Telephone Number : 217-714-7042
Fax Number :
Provider Business Practice Location Address
First Line : 2206 EASTLAND DR STE 101
Second Line :
City : BLOOMINGTON
State : IL
Zip : 61704-7742
Country : US
Telephone Number : 217-714-7042
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/20/2020
Last Update Date : 03/13/2026

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Directions to “ TARA VALENTINE ” Practice Location

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