Healthcare Provider Details

I. General information

NPI: 1942532908
Provider Name (Legal Business Name): TARA LYNNE WILLIAMS M.ED.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/25/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

243 BREWSTER RD
MCALESTER OK
74501-6379
US

IV. Provider business mailing address

243 BREWSTER RD
MCALESTER OK
74501-6379
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-0796
  • Fax:
Mailing address:
  • Phone: 918-689-0796
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: