Healthcare Provider Details

I. General information

NPI: 1346524683
Provider Name (Legal Business Name): SAMMIE CUNNINGHAM BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/05/2011
Last Update Date: 10/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 N WASHINGTON ST
ARDMORE OK
73401-7013
US

IV. Provider business mailing address

PO BOX 294
RINGLING OK
73456-0294
US

V. Phone/Fax

Practice location:
  • Phone: 580-226-5209
  • Fax: 580-226-5219
Mailing address:
  • Phone: 580-490-1730
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: