| Doctor Name: | MRS. TARA LYNN DIVELY |
| NPI Number: | 1386019990 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | M.A., LMFT |
| License Number: | MF000585 |
| Business Practice Address: | 29 N Market St Selinsgrove, PA - 178701924 |
| Business Phone Number: | 7172218004 |
| Business Fax Number: | 7172218006 |
| Mailing Address: | 2019 N 2nd St, HARRISBURG |
| State: | PA |
| Postal Code: | 171022147 |
| Phone Number: | 7172218004 |
| Fax Number: | 7172218006 |
| NPI Enumeration Date: | 12/08/2015 |
| NPI Last Update Date: | 12/08/2015 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | MF000585 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | PA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |