Active NPI
Tara Lynn Thomasson Prestridge, LPC
- Professional Counselor
- Fayetteville, AR
National Provider Identifier
1346455169
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- P1110085
- Practice address
- 1846 N Best Friend LN
Fayetteville, AR 72704-6520 - Phone
- (501) 624-7111
- Fax
- (501) 620-5109
- NPI assigned
- May 14, 2007
- Sex
- Female
- Sole proprietor
- No
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 2
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Counselor | 101Y00000X | A0803025 | AR | |
| Professional Counselor | 101YP2500X | P1110085 | AR | Primary |
Addresses
Primary practice location
1846 N Best Friend LN
Fayetteville, AR 72704-6520
Mailing address
1846 N Best Friend LN
Fayetteville, AR 72704-6520
Phone (870) 866-0681
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 116399726 | Medicaid | AR |
Other names 1
- Ms. Tara Lynn Davis
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 |
|---|---|---|---|
| A0803025 | AR | MD | Counselor |
| P1110085 | AR | MD | Professional Counselor |
Practice roles
| Organization | Specialty | Status | New patients |
|---|---|---|---|
| Tara P Therapy, PLLC | Professional | Past | Accepting new patients |
Organizations & group practices 1
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.
-
- Professional Counselor
- Farmington, AR
- NPI 1457842049
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1179100800000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1520467200000",
"number": "1346455169",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1846 N BEST FRIEND LN",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727046520",
"telephone_number": "870-866-0681"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1846 N BEST FRIEND LN",
"city": "FAYETTEVILLE",
"state": "AR",
"postal_code": "727046520",
"telephone_number": "501-624-7111",
"fax_number": "501-620-5109"
}
],
"practiceLocations": [],
"basic": {
"last_name": "PRESTRIDGE",
"first_name": "TARA",
"middle_name": "LYNN THOMASSON",
"name_prefix": "Mrs.",
"credential": "LPC",
"sole_proprietor": "NO",
"sex": "F",
"enumeration_date": "2007-05-14",
"last_updated": "2018-03-08",
"status": "A"
},
"taxonomies": [
{
"code": "101Y00000X",
"taxonomy_group": "",
"desc": "Counselor",
"state": "AR",
"license": "A0803025",
"primary": false
},
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "AR",
"license": "P1110085",
"primary": true
}
],
"identifiers": [
{
"code": "05",
"desc": "MEDICAID",
"issuer": null,
"identifier": "116399726",
"state": "AR"
}
],
"endpoints": [],
"other_names": [
{
"first_name": "TARA",
"last_name": "DAVIS",
"middle_name": "LYNN",
"prefix": "MS.",
"credential": "LPC",
"code": "1",
"type": "Former Name"
}
]
}Other providers in Fayetteville, AR
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 8, 2018; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.