| Doctor Name: | MS. TARA JEAN KELLEY |
| NPI Number: | 1093063505 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.S., L.P.C. |
| License Number: | 178002726 |
| Business Practice Address: | 403 Dysart St Columbia, MO - 652014323 |
| Business Phone Number: | 5734494770 |
| Business Fax Number: | 5734494851 |
| Mailing Address: | 2400 Braemore Rd, COLUMBIA |
| State: | MO |
| Postal Code: | 652031304 |
| Phone Number: | 5635087817 |
| Fax Number: | |
| NPI Enumeration Date: | 08/15/2012 |
| NPI Last Update Date: | 08/15/2012 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101Y00000X |
| License Number: | 178002726 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | IL |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A provider who is trained and educated in the performance of behavior health services through interpersonal communications and analysis. Training and education at the specialty level usually requires a master |