Active NPI
Tara Boddie
- Mental Health Counselor
- Ocoee, FL
National Provider Identifier
1134763071
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Mental Health Counselor
- License
- IMH18660
- Practice address
- 2038 Arden Oaks Dr
Ocoee, FL 34761-8448 - Phone
- (404) 429-3747
- NPI assigned
- Nov 4, 2019
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | IMH18660 | FL | Primary |
Addresses
Primary practice location
2038 Arden Oaks Dr
Ocoee, FL 34761-8448
Mailing address
2038 Arden Oaks Dr
Ocoee, FL 34761-8448
Phone (404) 429-3747
Electronic endpoints 1
| Type | Endpoint | Use | Affiliation |
|---|---|---|---|
| CONNECT URL | Orlando | Direct |
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| IMH18660 | FL | MD | Mental Health Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1572825600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1572825600000",
"number": "1134763071",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "2038 ARDEN OAKS DR",
"city": "OCOEE",
"state": "FL",
"postal_code": "347618448",
"telephone_number": "404-429-3747"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "2038 ARDEN OAKS DR",
"city": "OCOEE",
"state": "FL",
"postal_code": "347618448",
"telephone_number": "404-429-3747"
}
],
"practiceLocations": [],
"basic": {
"last_name": "BODDIE",
"first_name": "TARA",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2019-11-04",
"last_updated": "2019-11-04",
"status": "A"
},
"taxonomies": [
{
"code": "101YM0800X",
"taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
"desc": "Counselor, Mental Health",
"state": "FL",
"license": "IMH18660",
"primary": true
}
],
"identifiers": [],
"endpoints": [
{
"endpointType": "CONNECT",
"endpointTypeDescription": "CONNECT URL",
"endpoint": "Orlando",
"affiliation": "N",
"use": "DIRECT",
"useDescription": "Direct",
"contentType": "CSV",
"contentTypeDescription": "CSV",
"address_1": "2038 Arden Oaks Dr",
"city": "Ocoee",
"state": "FL",
"country_code": "US",
"postal_code": "347618448",
"country_name": "United States",
"address_type": "DOM"
}
],
"other_names": []
}Other providers in Ocoee, FL
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 4, 2019; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.