Provider Demographics
NPI:1376782730
Name:FRITSCH, TARA WINN (MA, LMFT)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:WINN
Last Name:FRITSCH
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16301 SONOMA PARK DR
Mailing Address - Street 2:TLCC
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-2091
Mailing Address - Country:US
Mailing Address - Phone:405-623-8899
Mailing Address - Fax:
Practice Address - Street 1:16301 SONOMA PARK DR
Practice Address - Street 2:TLCC
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-2091
Practice Address - Country:US
Practice Address - Phone:405-623-8899
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-09
Last Update Date:2009-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK924101YM0800X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist