Provider Demographics
NPI:1164797692
Name:AMADOR, EDNA MARLENY
Entity Type:Individual
Prefix:
First Name:EDNA
Middle Name:MARLENY
Last Name:AMADOR
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 1:6301 N MERIDIAN AVE
Mailing Address - Street 2:SUITE 102
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-1267
Mailing Address - Country:US
Mailing Address - Phone:405-604-6801
Mailing Address - Fax:405-604-8791
Practice Address - Street 1:6301 N MERIDIAN AVE
Practice Address - Street 2:SUITE 102
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-1267
Practice Address - Country:US
Practice Address - Phone:405-604-6801
Practice Address - Fax:405-604-8791
Is Sole Proprietor?:No
Enumeration Date:2012-03-16
Last Update Date:2012-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health