Provider Demographics
NPI:1467830554
Name:EVA HARTLEY LPC LADC PLLC
Entity Type:Organization
Organization Name:EVA HARTLEY LPC LADC PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ETHEL
Authorized Official - Middle Name:EVA
Authorized Official - Last Name:HARTLEY
Authorized Official - Suffix:
Authorized Official - Credentials:LPC LADC
Authorized Official - Phone:405-240-2469
Mailing Address - Street 1:414 W. MONROE
Mailing Address - Street 2:
Mailing Address - City:PUECELL
Mailing Address - State:OK
Mailing Address - Zip Code:74878
Mailing Address - Country:US
Mailing Address - Phone:405-420-2469
Mailing Address - Fax:
Practice Address - Street 1:414 W MONROE ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-3208
Practice Address - Country:US
Practice Address - Phone:405-420-2469
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-11
Last Update Date:2015-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5490261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health