Provider Demographics
NPI:1023561032
Name:TREADWELL, AMY (MA)
Entity Type:Individual
Prefix:
First Name:AMY
Middle Name:
Last Name:TREADWELL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:217 S ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7105
Mailing Address - Country:US
Mailing Address - Phone:405-902-5808
Mailing Address - Fax:
Practice Address - Street 1:1305 N SHARTEL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73103-2403
Practice Address - Country:US
Practice Address - Phone:405-702-6677
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-07-26
Last Update Date:2016-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health