Provider Demographics
NPI:1114540051
Name:TABOR, FREDRICKA (QBHP)
Entity Type:Individual
Prefix:
First Name:FREDRICKA
Middle Name:
Last Name:TABOR
Suffix:
Gender:F
Credentials:QBHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2230 HARRISON ST
Mailing Address - Street 2:
Mailing Address - City:BATESVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72501-7417
Mailing Address - Country:US
Mailing Address - Phone:870-698-2100
Mailing Address - Fax:870-698-0109
Practice Address - Street 1:2230 HARRISON ST
Practice Address - Street 2:
Practice Address - City:BATESVILLE
Practice Address - State:AR
Practice Address - Zip Code:72501-7417
Practice Address - Country:US
Practice Address - Phone:870-698-2100
Practice Address - Fax:870-698-0109
Is Sole Proprietor?:No
Enumeration Date:2020-05-27
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARP2311004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional