Provider Demographics
NPI:1437419314
Name:TUTTLE, TARA (LMHC)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:
Last Name:TUTTLE
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:STEPHENS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:1928 HOMEWOOD AVE
Mailing Address - Street 2:
Mailing Address - City:MISHAWAKA
Mailing Address - State:IN
Mailing Address - Zip Code:46544-2638
Mailing Address - Country:US
Mailing Address - Phone:574-387-7904
Mailing Address - Fax:
Practice Address - Street 1:401 W BRISTOL ST
Practice Address - Street 2:
Practice Address - City:ELKHART
Practice Address - State:IN
Practice Address - Zip Code:46514-3019
Practice Address - Country:US
Practice Address - Phone:574-402-1400
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-05-24
Last Update Date:2024-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003234A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health