Provider Demographics
NPI:1497905988
Name:DICKSON, TARA N (BS)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:N
Last Name:DICKSON
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 66
Mailing Address - Street 2:
Mailing Address - City:CANUTE
Mailing Address - State:OK
Mailing Address - Zip Code:73626-0066
Mailing Address - Country:US
Mailing Address - Phone:580-323-6021
Mailing Address - Fax:580-323-0828
Practice Address - Street 1:90 N 31ST ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-9116
Practice Address - Country:US
Practice Address - Phone:580-323-6021
Practice Address - Fax:580-323-0828
Is Sole Proprietor?:No
Enumeration Date:2008-09-22
Last Update Date:2008-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor