Provider Demographics
NPI:1487258232
Name:WILLSON, TARA MICHELLE (MA, LPC)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:MICHELLE
Last Name:WILLSON
Suffix:
Gender:F
Credentials:MA, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1821 N LAKE FOREST DR # 700233
Mailing Address - Street 2:
Mailing Address - City:MCKINNEY
Mailing Address - State:TX
Mailing Address - Zip Code:75071-7660
Mailing Address - Country:US
Mailing Address - Phone:972-214-4833
Mailing Address - Fax:
Practice Address - Street 1:800 HERON CREEK PASS
Practice Address - Street 2:
Practice Address - City:MCKINNEY
Practice Address - State:TX
Practice Address - Zip Code:75071-1501
Practice Address - Country:US
Practice Address - Phone:214-783-2006
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-11-23
Last Update Date:2025-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX80424101Y00000X, 101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor