Individual provider Active NPI

Tara Elizabeth Mullins, LCSW

  • Clinical Social Worker
  • Evansville, IN
National Provider Identifier
1265728265
Registry record updated Jul 17, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical Social WorkerTaxonomy code 1041C0700X
License
34010508A Issued in IN
Practice address
415 W Columbia St Ste 110
Evansville, IN 47710-1656
Phone
(812) 450-3363
Fax
(812) 450-3071
NPI assigned
Jun 28, 2011
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jul 17, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 2

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Social Worker 1041C0700X 6082 KY
Clinical Social Worker 1041C0700X 34010508A IN Primary

Addresses

Primary practice location

415 W Columbia St Ste 110
Evansville, IN 47710-1656

Mailing address

PO Box 3407
Evansville, IN 47733-3407
Phone (812) 450-3363

Other names 1

  • Tara Elizabeth Green Former name

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Enrolled in IN
Eligible to order & refer
  • Part B services: Yes
  • Medical equipment: Yes
  • Home health: No
  • Power mobility devices: No
  • Hospice: No
Green means eligible to order or refer.

Enrollment records 1

Enrollment IDStateProvider typePAC IDDetails
I20230809003967 IN Practitioner - Clinical Social Worker 2365804218 Reassigns benefits to 1 organization

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled

State licenses

LicenseStateTypeSpecialty
6082KYMDClinical Social Worker

Practice roles

OrganizationSpecialtyStatusNew patients
Deaconess Hospital Inc Clinical CurrentSince Jul 9, 2023 Accepting new patients
Deaconess Hospital, Inc. Clinical CurrentSince Jul 9, 2023 Accepting new patients
Deaconess Hospital, Inc Current Accepting new patients
Lifeskills, Inc. Past Accepting new patients

Locations

415 W Columbia St
#110
Evansville, IN 47710
Phone (812) 450-3363

415 W Columbia St
Ste 110
Evansville, IN 47710
Phone (812) 450-3363

4600 W Lloyd Expy
Evansville, IN 47712
Phone (812) 450-6311

Organizations & group practices 4

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1309219200000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1689552000000",
    "number": "1265728265",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 3407",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477333407",
            "telephone_number": "812-450-3363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "415 W COLUMBIA ST STE 110",
            "city": "EVANSVILLE",
            "state": "IN",
            "postal_code": "477101656",
            "telephone_number": "812-450-3363",
            "fax_number": "812-450-3071"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "MULLINS",
        "first_name": "TARA",
        "middle_name": "ELIZABETH",
        "credential": "LCSW",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2011-06-28",
        "last_updated": "2023-07-17",
        "certification_date": "2023-07-17",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "KY",
            "license": "6082",
            "primary": false
        },
        {
            "code": "1041C0700X",
            "taxonomy_group": "",
            "desc": "Social Worker, Clinical",
            "state": "IN",
            "license": "34010508A",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "first_name": "TARA",
            "last_name": "GREEN",
            "middle_name": "ELIZABETH",
            "code": "1",
            "type": "Former Name"
        }
    ]
}

Other providers in Evansville, IN

Sources for this page

Verify at the official NPI Registry.