Provider Demographics
NPI:1255501144
Name:HATHCOAT, CALLIE ANN (LADC)
Entity Type:Individual
Prefix:MS
First Name:CALLIE
Middle Name:ANN
Last Name:HATHCOAT
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:720 COLLEGE CT
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4741
Mailing Address - Country:US
Mailing Address - Phone:918-453-0841
Mailing Address - Fax:
Practice Address - Street 1:720 COLLEGE CT
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4741
Practice Address - Country:US
Practice Address - Phone:918-453-0841
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-03-06
Last Update Date:2013-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK30101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)