Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2011036258 | MO |
NPI | 1003186735 |
---|---|
Provider Name | Ms. Tara Jean Forrester |
First Address | Springfield, MO 65804-0306 |
Second Address | Ozark, MO 65721-7634 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 11/01/2012 |
Last Update Date | 11/01/2012 |