Provider Demographics
NPI:1134493901
Name:GOLDSBOROUGH, TARA ANN (BS, BHRS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:ANN
Last Name:GOLDSBOROUGH
Suffix:
Gender:F
Credentials:BS, BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5019 NE 1182ND AVE
Mailing Address - Street 2:
Mailing Address - City:RED OAK
Mailing Address - State:OK
Mailing Address - Zip Code:74563-5120
Mailing Address - Country:US
Mailing Address - Phone:918-448-7473
Mailing Address - Fax:918-465-5325
Practice Address - Street 1:5019 NE 1182ND AVE
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:OK
Practice Address - Zip Code:74563-5120
Practice Address - Country:US
Practice Address - Phone:918-448-7473
Practice Address - Fax:918-465-5325
Is Sole Proprietor?:Yes
Enumeration Date:2012-02-26
Last Update Date:2012-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health