Provider Demographics
NPI:1467685313
Name:GREEN, TAMMY DAWN (MA)
Entity Type:Individual
Prefix:
First Name:TAMMY
Middle Name:DAWN
Last Name:GREEN
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2123 LAKECREST DR
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7462
Mailing Address - Country:US
Mailing Address - Phone:405-820-6247
Mailing Address - Fax:
Practice Address - Street 1:6801 S WESTERN AVE
Practice Address - Street 2:SUITE 206
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73139-1817
Practice Address - Country:US
Practice Address - Phone:405-600-1042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-08-26
Last Update Date:2009-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health