Provider Demographics
NPI:1811547599
Name:STARK, TARA (PSYD)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:STARK
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:ARREOLA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PSYD
Mailing Address - Street 1:5122 FLINT ROCK LN
Mailing Address - Street 2:
Mailing Address - City:TEMPLE
Mailing Address - State:TX
Mailing Address - Zip Code:76502-8714
Mailing Address - Country:US
Mailing Address - Phone:254-262-6626
Mailing Address - Fax:
Practice Address - Street 1:5122 FLINT ROCK LN
Practice Address - Street 2:
Practice Address - City:TEMPLE
Practice Address - State:TX
Practice Address - Zip Code:76502-8714
Practice Address - Country:US
Practice Address - Phone:254-262-6626
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-09-16
Last Update Date:2025-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLPY10427103T00000X
NY021661103T00000X
COPSY.0006305103T00000X
TX39172103T00000X, 103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103T00000XBehavioral Health & Social Service ProvidersPsychologist