Provider Demographics
NPI:1861103087
Name:TITTLE, TARA ANN
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:TITTLE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4105 SHELBY CT
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022-0925
Mailing Address - Country:US
Mailing Address - Phone:830-305-6202
Mailing Address - Fax:
Practice Address - Street 1:1100 PARKER SQ STE 245
Practice Address - Street 2:
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-7459
Practice Address - Country:US
Practice Address - Phone:972-899-1848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2022-12-08
Last Update Date:2025-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX89604101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health