Provider Demographics
NPI:1316364789
Name:MSONGAMWANJA, HALLIE (LPC)
Entity Type:Individual
Prefix:
First Name:HALLIE
Middle Name:
Last Name:MSONGAMWANJA
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:HALLIE
Other - Middle Name:
Other - Last Name:MCMILLEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:6440 S LEWIS AVE STE 2900
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-1032
Mailing Address - Country:US
Mailing Address - Phone:918-212-4799
Mailing Address - Fax:
Practice Address - Street 1:6440 S LEWIS AVE STE 2900
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74136-1032
Practice Address - Country:US
Practice Address - Phone:918-212-4799
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2014-03-24
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6146101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor