Provider Demographics
NPI:1063026433
Name:HESS, KOHANNAH (BS)
Entity Type:Individual
Prefix:
First Name:KOHANNAH
Middle Name:
Last Name:HESS
Suffix:
Gender:F
Credentials:BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1222 10TH STREET
Mailing Address - Street 2:SUITE 211
Mailing Address - City:WOODWARD
Mailing Address - State:OK
Mailing Address - Zip Code:73801-3156
Mailing Address - Country:US
Mailing Address - Phone:580-571-3225
Mailing Address - Fax:580-256-8609
Practice Address - Street 1:604 CHOCTAW STREET
Practice Address - Street 2:
Practice Address - City:ALVA
Practice Address - State:OK
Practice Address - Zip Code:73717-3221
Practice Address - Country:US
Practice Address - Phone:580-327-1112
Practice Address - Fax:580-327-3067
Is Sole Proprietor?:Yes
Enumeration Date:2020-09-03
Last Update Date:2023-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1435101YA0400X
171M00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty