Provider Demographics
NPI:1356853337
Name:HAMM, KRISTEN BISSELL (MS)
Entity Type:Individual
Prefix:
First Name:KRISTEN
Middle Name:BISSELL
Last Name:HAMM
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 1:902 N JIM THORPE BLVD
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-4523
Mailing Address - Country:US
Mailing Address - Phone:405-567-5633
Mailing Address - Fax:
Practice Address - Street 1:1390 S DOUGLAS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5271
Practice Address - Country:US
Practice Address - Phone:405-610-2403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-10-30
Last Update Date:2017-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional