Healthcare Provider Details

I. General information

NPI: 1679147292
Provider Name (Legal Business Name): TARA HATCHER
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/18/2021
Last Update Date: 05/18/2021
Certification Date: 05/18/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6510 S WESTERN AVE STE 400
OKLAHOMA CITY OK
73139-1712
US

IV. Provider business mailing address

15400 SW 29TH ST
EL RENO OK
73036-9626
US

V. Phone/Fax

Practice location:
  • Phone: 405-634-1497
  • Fax: 405-634-1919
Mailing address:
  • Phone: 405-698-4948
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: