Healthcare Provider Details

I. General information

NPI: 1063026433
Provider Name (Legal Business Name): KOHANNAH HESS BS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/03/2020
Last Update Date: 04/17/2023
Certification Date: 04/17/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 CHOCTAW STREET
ALVA OK
73717-3221
US

IV. Provider business mailing address

1222 10TH STREET SUITE 211
WOODWARD OK
73801-3156
US

V. Phone/Fax

Practice location:
  • Phone: 580-327-1112
  • Fax: 580-327-3067
Mailing address:
  • Phone: 580-571-3225
  • Fax: 580-256-8609

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number1435
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: