| Doctor Name: | MS. TARA L ELLESTAD |
| NPI Number: | 1215005798 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LPC |
| License Number: | 3453 |
| Business Practice Address: | 627 Main St Darlington, WI - 535301395 |
| Business Phone Number: | 6087764800 |
| Business Fax Number: | 6087764914 |
| Mailing Address: | 7633 Ganser Way Ste 204, MADISON |
| State: | WI |
| Postal Code: | 537192092 |
| Phone Number: | 6088291800 |
| Fax Number: | 6088291885 |
| NPI Enumeration Date: | 12/01/2006 |
| NPI Last Update Date: | 06/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 3453 |
| Healthcare Provider Taxonomy: (Secondary) | N |
| State: | WI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |