Healthcare Provider Details

I. General information

NPI: 1366183907
Provider Name (Legal Business Name): TIAMARA DREW LMFT-C
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/06/2022
Last Update Date: 04/06/2022
Certification Date: 04/06/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

198 E ALMAR DR
CHICKASHA OK
73018-7327
US

IV. Provider business mailing address

PO BOX 829
CHICKASHA OK
73023-0829
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-5437
  • Fax:
Mailing address:
  • Phone: 405-222-5437
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: