Provider Demographics
NPI:1942580204
Name:MCDONALD, TARAE MICHELLE (BHRS)
Entity Type:Individual
Prefix:MS
First Name:TARAE
Middle Name:MICHELLE
Last Name:MCDONALD
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 1:8301 N COUNCIL RD APT 709
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-4185
Mailing Address - Country:US
Mailing Address - Phone:405-812-1497
Mailing Address - Fax:
Practice Address - Street 1:8301 N COUNCIL RD APT 709
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-4185
Practice Address - Country:US
Practice Address - Phone:405-812-1497
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-18
Last Update Date:2011-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator