Provider Demographics
NPI:1215683198
Name:TANNAHILL, HALLIE SARAH (PHD)
Entity type:Individual
Prefix:
First Name:HALLIE
Middle Name:SARAH
Last Name:TANNAHILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5204 SUNNYBROOK LN
Mailing Address - Street 2:
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76310-3497
Mailing Address - Country:US
Mailing Address - Phone:443-668-6115
Mailing Address - Fax:
Practice Address - Street 1:527 TUSKEGEE AIRMAN AVE
Practice Address - Street 2:
Practice Address - City:SHEPPARD AIR FORCE BASE
Practice Address - State:TX
Practice Address - Zip Code:76311
Practice Address - Country:US
Practice Address - Phone:940-676-6075
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-03-01
Last Update Date:2024-02-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA00000000103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical