Provider Demographics
NPI:1942292180
Name:KAMPEN, TARA MICHELLE (LIMHP)
Entity type:Individual
Prefix:MRS
First Name:TARA
Middle Name:MICHELLE
Last Name:KAMPEN
Suffix:
Gender:F
Credentials:LIMHP
Other - Prefix:MS
Other - First Name:TARA
Other - Middle Name:MICHELLE
Other - Last Name:JOHNSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:19511 JOSEPHINE ST
Mailing Address - Street 2:
Mailing Address - City:GRETNA
Mailing Address - State:NE
Mailing Address - Zip Code:68028-4271
Mailing Address - Country:US
Mailing Address - Phone:402-861-9088
Mailing Address - Fax:
Practice Address - Street 1:1045 N 115TH ST STE 205
Practice Address - Street 2:
Practice Address - City:OMAHA
Practice Address - State:NE
Practice Address - Zip Code:68154-4422
Practice Address - Country:US
Practice Address - Phone:402-403-9892
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2005-08-15
Last Update Date:2025-01-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE10980101YM0800X
NE5335101YM0800X
NE3951101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health