Provider Demographics
NPI:1417159690
Name:TAINPEAH, RAY
Entity Type:Individual
Prefix:MR
First Name:RAY
Middle Name:
Last Name:TAINPEAH
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:RAY
Other - Middle Name:
Other - Last Name:TAINPEAH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:PO BOX 417
Mailing Address - Street 2:
Mailing Address - City:PRAGUE
Mailing Address - State:OK
Mailing Address - Zip Code:74864-0417
Mailing Address - Country:US
Mailing Address - Phone:405-395-7398
Mailing Address - Fax:
Practice Address - Street 1:2307 S GORDON COOPER DR
Practice Address - Street 2:
Practice Address - City:SHAWNEE
Practice Address - State:OK
Practice Address - Zip Code:74801-9007
Practice Address - Country:US
Practice Address - Phone:405-273-5236
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-06-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK472101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)