Provider Demographics
NPI:1063996676
Name:KEGLEY, TABATHA (BSW)
Entity type:Individual
Prefix:MRS
First Name:TABATHA
Middle Name:
Last Name:KEGLEY
Suffix:
Gender:F
Credentials:BSW
Other - Prefix:MISS
Other - First Name:TABATHA
Other - Middle Name:
Other - Last Name:ALVAREZ
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:BSW
Mailing Address - Street 1:233 E 84TH DR STE 205
Mailing Address - Street 2:
Mailing Address - City:MERRILLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46410-6399
Mailing Address - Country:US
Mailing Address - Phone:219-472-2062
Mailing Address - Fax:219-576-6090
Practice Address - Street 1:233 E 84TH DR STE 205
Practice Address - Street 2:
Practice Address - City:MERRILLVILLE
Practice Address - State:IN
Practice Address - Zip Code:46410-6399
Practice Address - Country:US
Practice Address - Phone:219-472-2062
Practice Address - Fax:219-576-6090
Is Sole Proprietor?:Yes
Enumeration Date:2018-09-19
Last Update Date:2018-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker