Provider Demographics
NPI:1164738316
Name:NAM, INCHUL (LPC)
Entity Type:Individual
Prefix:MR
First Name:INCHUL
Middle Name:
Last Name:NAM
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:412 N. TELEPHONE RD.
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160
Mailing Address - Country:US
Mailing Address - Phone:405-794-5552
Mailing Address - Fax:405-759-2492
Practice Address - Street 1:412 N. TELEPHONE RD.
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160
Practice Address - Country:US
Practice Address - Phone:405-794-5552
Practice Address - Fax:405-759-2492
Is Sole Proprietor?:No
Enumeration Date:2010-08-25
Last Update Date:2015-03-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK4923101YP2500X
101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor