Provider Demographics
NPI:1093145674
Name:DAVENPORT, TAMY
Entity Type:Individual
Prefix:MS
First Name:TAMY
Middle Name:
Last Name:DAVENPORT
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 1:2609 OAKHURST DR
Mailing Address - Street 2:APT. B
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-4673
Mailing Address - Country:US
Mailing Address - Phone:580-332-8285
Mailing Address - Fax:
Practice Address - Street 1:111 EAST 12TH STREET
Practice Address - Street 2:
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820
Practice Address - Country:US
Practice Address - Phone:580-436-2690
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-11-19
Last Update Date:2013-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health