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General NPI Number Information
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NPI Number | 1376185173
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Entity Type | Individual
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Provider Name | BRITTANI NICOLE HAM
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Gender | Female
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Dates
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Enumeration Date | 10/13/2019
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Last Update Date | 03/05/2024
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Provider Practice Location Address
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Address Line | 2557 S CRESTVIEW RD
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City | ATOKA
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State | OK
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Zip | 74525-6337
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Country | US
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Telephone | 918-302-8422
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Fax |
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Provider Business Mailing Address
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Address Line | 186 W COURT ST
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City | ATOKA
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State | OK
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Zip | 74525-1822
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Country | US
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Telephone | 918-470-5566
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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