Provider Demographics
NPI:1306477492
Name:OAKLEY, TARA LYNN (LSW)
Entity type:Individual
Prefix:MS
First Name:TARA
Middle Name:LYNN
Last Name:OAKLEY
Suffix:
Gender:F
Credentials:LSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5511 CALLE DE ORO
Mailing Address - Street 2:
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47712-2726
Mailing Address - Country:US
Mailing Address - Phone:812-205-3084
Mailing Address - Fax:
Practice Address - Street 1:545 WILLOW ST
Practice Address - Street 2:
Practice Address - City:VINCENNES
Practice Address - State:IN
Practice Address - Zip Code:47591-1064
Practice Address - Country:US
Practice Address - Phone:812-882-0509
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-01-28
Last Update Date:2020-01-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN99093521A104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker