Healthcare Provider Details

I. General information

NPI: 1790049690
Provider Name (Legal Business Name): RANADA HULSEY MS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/26/2012
Last Update Date: 09/10/2025
Certification Date: 09/10/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 E MAIN ST
TISHOMINGO OK
73460-2341
US

IV. Provider business mailing address

309 E MAIN ST
TISHOMINGO OK
73460-2341
US

V. Phone/Fax

Practice location:
  • Phone: 580-371-5480
  • Fax:
Mailing address:
  • Phone: 580-371-5480
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number23322
License Number StateAZ
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6380
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: