Provider Demographics
NPI:1851753362
Name:HALL, TARA J (LPC)
Entity Type:Individual
Prefix:MRS
First Name:TARA
Middle Name:J
Last Name:HALL
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:TARA
Other - Middle Name:J
Other - Last Name:GLOVER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8518 S PENNSYLVANIA AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-5226
Mailing Address - Country:US
Mailing Address - Phone:972-978-2542
Mailing Address - Fax:
Practice Address - Street 1:8518 S PENNSYLVANIA AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-5226
Practice Address - Country:US
Practice Address - Phone:972-978-2542
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-23
Last Update Date:2016-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5980101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional