Healthcare Provider Details

I. General information

NPI: 1164845426
Provider Name (Legal Business Name): MS. TAMRA SNELSON
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/22/2014
Last Update Date: 02/24/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

504 W BROADWAY ST
HENRYETTA OK
74437-5214
US

IV. Provider business mailing address

504 W BROADWAY ST
HENRYETTA OK
74437-5214
US

V. Phone/Fax

Practice location:
  • Phone: 918-650-9500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code1041S0200X
TaxonomySchool Social Worker
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: