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General NPI Number Information
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NPI Number | 1205214210
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Entity Type | Individual
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Provider Name | AMANDA CONDREN
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Gender | Female
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Dates
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Enumeration Date | 05/11/2015
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Last Update Date | 12/22/2024
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Provider Practice Location Address
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Address Line | 20119 E FARRIS CEMETERY RD
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City | ATOKA
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State | OK
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Zip | 74525-6050
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Country | US
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Telephone | 580-364-6960
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Fax |
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Provider Business Mailing Address
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Address Line | 1031 S GRIFFIN RD
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City | ATOKA
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State | OK
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Zip | 74525-8403
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Country | US
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Telephone | 580-364-6960
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5127
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License Number State | OK
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