Individual
MS. TARA L ELLESTAD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
627 MAIN ST, DARLINGTON, WI 53530-1395
(608) 776-4800
(608) 776-4914
Mailing address
7633 GANSER WAY STE 204, MADISON, WI 53719-2092
(608) 829-1800
(608) 829-1885
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
3453
WI
101YM0800X
Mental Health Counselor
3453
WI
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
40966400
—
WI
Enumeration date
12/01/2006
Last updated
06/08/2015
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