Provider Demographics
NPI:1942194881
Name:MANOR, TARA R
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:R
Last Name:MANOR
Suffix:
Gender:X
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:525 NEPTUNE DR APT 814
Mailing Address - Street 2:
Mailing Address - City:CLARKSVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37043-2327
Mailing Address - Country:US
Mailing Address - Phone:931-278-8201
Mailing Address - Fax:
Practice Address - Street 1:101 HATCHER LN STE D
Practice Address - Street 2:
Practice Address - City:CLARKSVILLE
Practice Address - State:TN
Practice Address - Zip Code:37043-6496
Practice Address - Country:US
Practice Address - Phone:931-444-5630
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2025-06-05
Last Update Date:2025-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health