Provider Demographics
NPI:1902966963
Name:HENESEY, TARA LYNN (LMSW)
Entity Type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:HENESEY
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:20149 W 219TH TER
Mailing Address - Street 2:
Mailing Address - City:SPRING HILL
Mailing Address - State:KS
Mailing Address - Zip Code:66083-7800
Mailing Address - Country:US
Mailing Address - Phone:913-909-9669
Mailing Address - Fax:
Practice Address - Street 1:480 S ROGERS RD
Practice Address - Street 2:KIDS TLC, INC.
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062-1706
Practice Address - Country:US
Practice Address - Phone:913-764-2887
Practice Address - Fax:913-780-3387
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2013-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS5018104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker