Doctor Name: | TARA ANN GOLDSBOROUGH |
NPI Number: | 1134493901 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | B.S., BHRS |
License Number: | |
Business Practice Address: | 5019 Ne 1182nd Ave Red Oak, OK - 745635120 |
Business Phone Number: | 9184487473 |
Business Fax Number: | 9184655325 |
Mailing Address: | 5019 Ne 1182nd Ave, RED OAK |
State: | OK |
Postal Code: | 745635120 |
Phone Number: | 9184487473 |
Fax Number: | 9184655325 |
NPI Enumeration Date: | 02/26/2012 |
NPI Last Update Date: | 02/26/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |