Provider Demographics
NPI:1376981050
Name:WARREN, TAMARA KAY
Entity Type:Individual
Prefix:
First Name:TAMARA
Middle Name:KAY
Last Name:WARREN
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:TAMARA
Other - Middle Name:KAY
Other - Last Name:COIN
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:10110 SHADOWRIDGE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7533
Mailing Address - Country:US
Mailing Address - Phone:405-410-1507
Mailing Address - Fax:
Practice Address - Street 1:10110 SHADOWRIDGE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7533
Practice Address - Country:US
Practice Address - Phone:405-410-1507
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-04
Last Update Date:2013-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional