Individual
TARA K WALLS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
141 TOWNSHIP AVE STE 303, RIDGELAND, MS 39157-8699
(601) 298-8586
Mailing address
PO BOX 1423, MADISON, MS 39130-1423
(601) 750-3717
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
P-742
MS
Other
Enumeration date
07/05/2022
Last updated
07/05/2022
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