Provider Demographics
NPI:1902103278
Name:BATCHELOR, TARA L (BCABA)
Entity type:Individual
Prefix:
First Name:TARA
Middle Name:L
Last Name:BATCHELOR
Suffix:
Gender:F
Credentials:BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 122
Mailing Address - Street 2:
Mailing Address - City:DURANT
Mailing Address - State:FL
Mailing Address - Zip Code:33530-0122
Mailing Address - Country:US
Mailing Address - Phone:813-784-4534
Mailing Address - Fax:813-650-0102
Practice Address - Street 1:7825 TURKEY CREEK RD
Practice Address - Street 2:
Practice Address - City:PLANT CITY
Practice Address - State:FL
Practice Address - Zip Code:33567-3027
Practice Address - Country:US
Practice Address - Phone:813-784-4534
Practice Address - Fax:813-650-0102
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-22
Last Update Date:2011-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0-03-0830103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst