Provider Demographics
NPI:1114334380
Name:ARTRECHES, TAHIRIN (PSYD)
Entity Type:Individual
Prefix:
First Name:TAHIRIN
Middle Name:
Last Name:ARTRECHES
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15131 OGDEN LOOP OFC 104
Mailing Address - Street 2:
Mailing Address - City:ODESSA
Mailing Address - State:FL
Mailing Address - Zip Code:33556-4633
Mailing Address - Country:US
Mailing Address - Phone:813-820-0677
Mailing Address - Fax:813-820-0677
Practice Address - Street 1:15131 OGDEN LOOP OFC 104
Practice Address - Street 2:
Practice Address - City:ODESSA
Practice Address - State:FL
Practice Address - Zip Code:33556-4633
Practice Address - Country:US
Practice Address - Phone:813-820-0677
Practice Address - Fax:813-820-0677
Is Sole Proprietor?:No
Enumeration Date:2014-07-18
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103G00000X
FLPY9060103TC0700X
FLPY 9060103G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103G00000XBehavioral Health & Social Service ProvidersClinical Neuropsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical