Provider Demographics
NPI:1033413034
Name:TINDELL, NATASHA KAYE (C-PRSS,CM)
Entity Type:Individual
Prefix:
First Name:NATASHA
Middle Name:KAYE
Last Name:TINDELL
Suffix:
Gender:F
Credentials:C-PRSS,CM
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:320 N PEBBLE CREEK TER APT 104
Mailing Address - Street 2:
Mailing Address - City:MUSTANG
Mailing Address - State:OK
Mailing Address - Zip Code:73064-4176
Mailing Address - Country:US
Mailing Address - Phone:405-887-8033
Mailing Address - Fax:
Practice Address - Street 1:320 N PEBBLE CREEK TER APT 104
Practice Address - Street 2:
Practice Address - City:MUSTANG
Practice Address - State:OK
Practice Address - Zip Code:73064-4176
Practice Address - Country:US
Practice Address - Phone:405-887-8033
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0162101Y00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK062009OtherOKLAHOMA STATE BAR ASSOCIATION CERTIFIED FAMILY & DIVORCE MEDIATOR
OK0162OtherODMHSAS