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NPI Code Detail

MEDICARE: PROF. TENAYE HAILU LMFT

MEDICARE: PROF. TENAYE HAILU LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist1096OK

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
11096OTHEROKLMFT

General Provider Information

NPI Number : 1336387315
Entity Type Code : Individual
Provider Name (Legal Business Name) : PROF. TENAYE HAILU LMFT
Provider Business Mailing Address
First Line : 7633 E 63RD PL STE 300
Second Line :
City : TULSA
State : OK
Zip : 74133-1202
Country : US
Telephone Number : 918-740-6195
Fax Number :
Provider Business Practice Location Address
First Line : 7633 E 63RD PL STE 300
Second Line :
City : TULSA
State : OK
Zip : 74133-1202
Country : US
Telephone Number : 918-740-6195
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 01/28/2009
Last Update Date : 09/09/2024

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Directions to “ PROF. TENAYE HAILU LMFT” Practice Location

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