Provider Demographics
NPI:1730514886
Name:FRICK, TARA (MA, PC)
Entity type:Individual
Prefix:MISS
First Name:TARA
Middle Name:
Last Name:FRICK
Suffix:
Gender:F
Credentials:MA, PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 636388
Mailing Address - Street 2:
Mailing Address - City:CINCINNATI
Mailing Address - State:OH
Mailing Address - Zip Code:45263-6388
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:419-936-7606
Practice Address - Street 1:4126 N HOLLAND SYLVANIA RD STE 220
Practice Address - Street 2:
Practice Address - City:TOLEDO
Practice Address - State:OH
Practice Address - Zip Code:43623-3537
Practice Address - Country:US
Practice Address - Phone:419-696-8877
Practice Address - Fax:419-696-8835
Is Sole Proprietor?:No
Enumeration Date:2013-09-09
Last Update Date:2020-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHC1200035101YM0800X
OHE.1800580101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health