Provider Demographics
NPI:1518152529
Name:HERNANDEZ, TAMI RANAE (MHR LPC)
Entity type:Individual
Prefix:MRS
First Name:TAMI
Middle Name:RANAE
Last Name:HERNANDEZ
Suffix:
Gender:F
Credentials:MHR LPC
Other - Prefix:MS
Other - First Name:TAMI
Other - Middle Name:RANAE
Other - Last Name:TALLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 358
Mailing Address - Street 2:527 WEST THIRD ST
Mailing Address - City:KONAWA
Mailing Address - State:OK
Mailing Address - Zip Code:74849
Mailing Address - Country:US
Mailing Address - Phone:580-925-3286
Mailing Address - Fax:580-925-2362
Practice Address - Street 1:527 WEST THIRD ST
Practice Address - Street 2:
Practice Address - City:KONAWA
Practice Address - State:OK
Practice Address - Zip Code:74849
Practice Address - Country:US
Practice Address - Phone:580-925-3286
Practice Address - Fax:580-925-2362
Is Sole Proprietor?:No
Enumeration Date:2007-09-12
Last Update Date:2010-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3125101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK3125OtherOK STATE DEPT OF HLTH