| Doctor Name: | MS. TARA FORTON |
| NPI Number: | 1689748121 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | LMSW |
| License Number: | 6801082238 |
| Business Practice Address: | 25594 Cortez St Harrison Township, MI - 480452028 |
| Business Phone Number: | 5863213029 |
| Business Fax Number: | 5864652341 |
| Mailing Address: | 25594 Cortez St, HARRISON TOWNSHIP |
| State: | MI |
| Postal Code: | 480452028 |
| Phone Number: | 5863213029 |
| Fax Number: | 5864652341 |
| NPI Enumeration Date: | 11/17/2006 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | 6801082238 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | MI |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |