Provider Demographics
NPI:1780922286
Name:HAHN PSYCHOLOGICAL SERVICES LLC
Entity type:Organization
Organization Name:HAHN PSYCHOLOGICAL SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:AGENCY DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JACOB
Authorized Official - Middle Name:TYLER
Authorized Official - Last Name:HAHN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD LPC
Authorized Official - Phone:918-815-7722
Mailing Address - Street 1:3515 E ADMIRAL CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74115-8205
Mailing Address - Country:US
Mailing Address - Phone:918-836-0239
Mailing Address - Fax:918-836-6101
Practice Address - Street 1:8906 E SKELLY DR STE J
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74129-3400
Practice Address - Country:US
Practice Address - Phone:918-815-7722
Practice Address - Fax:918-836-6101
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-18
Last Update Date:2013-01-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4862251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200404480BMedicaid