Healthcare Provider Details

I. General information

NPI: 1750596805
Provider Name (Legal Business Name): KAY M TAN MHR, LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/11/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2303 S YORK ST
MUSKOGEE OK
74403-8876
US

IV. Provider business mailing address

7409 S BIRMINGHAM CT
TULSA OK
74136-5512
US

V. Phone/Fax

Practice location:
  • Phone: 918-686-5588
  • Fax:
Mailing address:
  • Phone: 405-360-2133
  • Fax: 405-360-2252

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number2756
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: