=====================================================
General NPI Number Information
=====================================================
NPI Number | 1124400635
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | KEYS FOR HOPE PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/20/2015
-----------------------------------------------------
Last Update Date | 01/11/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 14020 N WESTERN AVE
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-1977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-822-7844
-----------------------------------------------------
Fax | 405-493-6760
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 14020 N WESTERN AVE
-----------------------------------------------------
City | EDMOND
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73013-1977
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-822-7844
-----------------------------------------------------
Fax | 405-493-6760
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER/PSYCHOLOGIST
-----------------------------------------------------
Name | DR. TAMARA TROWER
-----------------------------------------------------
Credential | PHD
-----------------------------------------------------
Telephone | 405-822-7844
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number | 1206
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 103T00000X
-----------------------------------------------------
Taxonomy Name | Psychologist
-----------------------------------------------------
License Number | 1206
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------