Provider Demographics
NPI:1952620213
Name:TARLETON, QWANNAH LACHE' (MHR LPC, US)
Entity Type:Individual
Prefix:MISS
First Name:QWANNAH
Middle Name:LACHE'
Last Name:TARLETON
Suffix:
Gender:F
Credentials:MHR LPC, US
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3700 N CLASSEN BLVD STE C35
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-2836
Mailing Address - Country:US
Mailing Address - Phone:405-606-8883
Mailing Address - Fax:405-606-8804
Practice Address - Street 1:3700 N CLASSEN BLVD STE C35
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73118-2836
Practice Address - Country:US
Practice Address - Phone:405-606-8883
Practice Address - Fax:405-606-8804
Is Sole Proprietor?:No
Enumeration Date:2010-05-26
Last Update Date:2021-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103K00000X
101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst