Provider Demographics
NPI:1144030537
Name:KING, TARA (QMHS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:KING
Suffix:
Gender:F
Credentials:QMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24051 RUSSELL AVE
Mailing Address - Street 2:
Mailing Address - City:EUCLID
Mailing Address - State:OH
Mailing Address - Zip Code:44123-2304
Mailing Address - Country:US
Mailing Address - Phone:216-804-0066
Mailing Address - Fax:
Practice Address - Street 1:17325 EUCLID AVE STE 3040
Practice Address - Street 2:
Practice Address - City:CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-1276
Practice Address - Country:US
Practice Address - Phone:216-804-0066
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH171M00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator