MEDICARE: KEELIE HAMM LPC-C

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
1	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1780241612
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KEELIE HAMM LPC-C

Provider Business Mailing Address
First Line	:	3010 S HARVARD AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6126
Country	:	US
Telephone Number	:	918-982-6150
Fax Number	:	918-982-6101

Provider Business Practice Location Address
First Line	:	3010 S HARVARD AVE STE 110
Second Line	:
City	:	TULSA
State	:	OK
Zip	:	74114-6126
Country	:	US
Telephone Number	:	918-982-6150
Fax Number	:	918-982-6101

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/27/2019
Last Update Date	:	05/27/2019

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