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General NPI Number Information
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NPI Number | 1972829901
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Entity Type | Individual
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Provider Name | LISA DE AMBER KOMAHCHEET LADC
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Gender | Female
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Dates
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Enumeration Date | 04/15/2010
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Last Update Date | 04/15/2010
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Provider Practice Location Address
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Address Line | 3212 SW 104TH TER 2915 N CLASSEN BLVD. SUITE 325
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7800
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Country | US
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Telephone | 405-213-3700
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Fax | 405-208-4574
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Provider Business Mailing Address
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Address Line | 3212 SW 104TH TER
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City | OKLAHOMA CITY
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State | OK
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Zip | 73159-7800
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Country | US
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Telephone | 405-213-3700
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Fax | 405-208-4574
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | #588
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License Number State | OK
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