Healthcare Provider Details

I. General information

NPI: 1184816480
Provider Name (Legal Business Name): CAMERON LANE HOLLINGSWORTH M.A.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/10/2007
Last Update Date: 02/05/2024
Certification Date: 02/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2911 ADAMS RD STE 101
NORMAN OK
73069-1023
US

IV. Provider business mailing address

2911 ADAMS RD STE 101
NORMAN OK
73069-1023
US

V. Phone/Fax

Practice location:
  • Phone: 405-310-3735
  • Fax: 405-310-3576
Mailing address:
  • Phone: 405-310-3735
  • Fax: 405-310-3576

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number1017
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number4485
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: