=====================================================
General NPI Number Information
=====================================================
NPI Number | 1922828276
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | TAMMY LOUISE FERRARI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/11/2024
-----------------------------------------------------
Last Update Date | 10/11/2024
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 320 S BOSTON AVE STE 825A
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74103-3728
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-609-0404
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1848 SURREY DR
-----------------------------------------------------
City | PRYOR
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74361-8429
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 479-561-4858
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number | LPCCANDIDATE12434
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------