Provider Demographics
NPI:1003223942
Name:HAMILTON, WYNEMA
Entity Type:Individual
Prefix:
First Name:WYNEMA
Middle Name:
Last Name:HAMILTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8117 E 19TH ST APT 12-205
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74112-8355
Mailing Address - Country:US
Mailing Address - Phone:918-269-5602
Mailing Address - Fax:
Practice Address - Street 1:8117 E 19TH ST APT 12-205
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74112-8355
Practice Address - Country:US
Practice Address - Phone:918-269-5602
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-07-11
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)