Provider Demographics
NPI:1215209606
Name:LAMAY, EDITH A (MS)
Entity Type:Individual
Prefix:
First Name:EDITH
Middle Name:A
Last Name:LAMAY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5110 S YALE AVE STE 103
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74135-7455
Mailing Address - Country:US
Mailing Address - Phone:918-779-7637
Mailing Address - Fax:918-938-6037
Practice Address - Street 1:5110 S YALE AVE
Practice Address - Street 2:STE 103
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74135-7401
Practice Address - Country:US
Practice Address - Phone:918-779-7637
Practice Address - Fax:918-938-6037
Is Sole Proprietor?:No
Enumeration Date:2012-02-01
Last Update Date:2012-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TC2200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK113796324Medicaid