Individual
TARA BANGTSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPCA
Contact information
Practice address
251 E MAXWELL ST, LEXINGTON, KY 40508-2636
(859) 255-0500
Mailing address
251 E MAXWELL ST, LEXINGTON, KY 40508-2636
(859) 255-0500
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
170613
KY
Other
Enumeration date
12/28/2016
Last updated
03/17/2018
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