Provider Demographics
NPI:1184860611
Name:VANTINE, NORMA JANE (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:NORMA
Middle Name:JANE
Last Name:VANTINE
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1503 S. DENVER AVE.
Mailing Address - Street 2:YWCA TULSA
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74119-3828
Mailing Address - Country:US
Mailing Address - Phone:918-588-9393
Mailing Address - Fax:918-588-9394
Practice Address - Street 1:1503 S. DENVER AVE.
Practice Address - Street 2:YWCA TULSA
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74119-3828
Practice Address - Country:US
Practice Address - Phone:918-588-9393
Practice Address - Fax:918-588-9394
Is Sole Proprietor?:No
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional