Provider Demographics
NPI:1073716270
Name:MASSEY, EVA (LADC)
Entity Type:Individual
Prefix:
First Name:EVA
Middle Name:
Last Name:MASSEY
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:EVA
Other - Middle Name:
Other - Last Name:MASSEY-HOTTEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC
Mailing Address - Street 1:815 S MACOMB AVE
Mailing Address - Street 2:
Mailing Address - City:EL RENO
Mailing Address - State:OK
Mailing Address - Zip Code:73036-4717
Mailing Address - Country:US
Mailing Address - Phone:405-262-5029
Mailing Address - Fax:
Practice Address - Street 1:7905 E. HWY 66
Practice Address - Street 2:
Practice Address - City:EL RENO
Practice Address - State:OK
Practice Address - Zip Code:73036
Practice Address - Country:US
Practice Address - Phone:405-264-5514
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK299101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)