Provider Demographics
NPI:1942536487
Name:CONNER, TARA (BHRS)
Entity Type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:CONNER
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:727 E WYANDOTTE AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5427
Mailing Address - Country:US
Mailing Address - Phone:918-420-5343
Mailing Address - Fax:918-420-5904
Practice Address - Street 1:CREOKS
Practice Address - Street 2:727 E. WYANDOTTE
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:919-420-5343
Practice Address - Fax:919-420-5904
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-18
Last Update Date:2023-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health