Provider Demographics
NPI:1144508367
Name:BROWN, TARA (BHRS)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:
Last Name:BROWN
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:TARA
Other - Middle Name:
Other - Last Name:STEVENSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:604 SEMINOLE DR
Mailing Address - Street 2:
Mailing Address - City:PAULS VALLEY
Mailing Address - State:OK
Mailing Address - Zip Code:73075-6424
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:604 SEMINOLE DR
Practice Address - Street 2:
Practice Address - City:PAULS VALLEY
Practice Address - State:OK
Practice Address - Zip Code:73075-6424
Practice Address - Country:US
Practice Address - Phone:405-251-0084
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-07-22
Last Update Date:2011-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health