Provider Demographics
NPI:1679147292
Name:HATCHER, TARA
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:HATCHER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:15400 SW 29TH ST
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-9626
Mailing Address - Country:US
Mailing Address - Phone:405-698-4948
Mailing Address - Fax:
Practice Address - Street 1:6510 S WESTERN AVE STE 400
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1712
Practice Address - Country:US
Practice Address - Phone:405-634-1497
Practice Address - Fax:405-634-1919
Is Sole Proprietor?:No
Enumeration Date:2021-05-18
Last Update Date:2021-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health