Provider Demographics
NPI:1538209481
Name:MILLS, TARA L (LCSW)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:MILLS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:251 DEMOCRAT DR
Mailing Address - Street 2:
Mailing Address - City:FRANKFORT
Mailing Address - State:KY
Mailing Address - Zip Code:40601-9214
Mailing Address - Country:US
Mailing Address - Phone:502-385-0695
Mailing Address - Fax:023-522-7065
Practice Address - Street 1:251 DEMOCRAT DR
Practice Address - Street 2:
Practice Address - City:FRANKFORT
Practice Address - State:KY
Practice Address - Zip Code:40601-9214
Practice Address - Country:US
Practice Address - Phone:502-385-0695
Practice Address - Fax:023-522-7065
Is Sole Proprietor?:No
Enumeration Date:2007-02-08
Last Update Date:2020-05-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X
KY33721041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY30615058Medicaid
KY30615058Medicaid