Provider Demographics
NPI:1851162895
Name:WHATLEY, TARAH (LPC-ASSOCIATE)
Entity Type:Individual
Prefix:
First Name:TARAH
Middle Name:
Last Name:WHATLEY
Suffix:
Gender:F
Credentials:LPC-ASSOCIATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2815 MONTGOMERY PL
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76308-3623
Mailing Address - Country:US
Mailing Address - Phone:940-224-2056
Mailing Address - Fax:
Practice Address - Street 1:712 8TH ST
Practice Address - Street 2:
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6510
Practice Address - Country:US
Practice Address - Phone:877-942-2239
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-01-09
Last Update Date:2024-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX92001101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health