Healthcare Provider Details

I. General information

NPI: 1366875155
Provider Name (Legal Business Name): MRS. TAMMY KAY MCFALLS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/15/2013
Last Update Date: 08/15/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 NW 10TH ST
OKLAHOMA CITY OK
73106-7220
US

IV. Provider business mailing address

1303 E CHICAGO ST
OKMULGEE OK
74447-7914
US

V. Phone/Fax

Practice location:
  • Phone: 918-482-4098
  • Fax:
Mailing address:
  • Phone: 918-756-3536
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: