Individual
TARA J BLACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
7019 LOUISE ST, SHREVEPORT, LA 71108
(318) 218-3896
Mailing address
7019 LOUISE ST, SHREVEPORT, LA 71108-4840
(318) 218-3896
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
—
—
104100000X
Social Worker
Primary
12403
LA
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
09/06/2016
Last updated
01/23/2025
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