Provider Demographics
NPI:1518236280
Name:HAWTHORNE, MINDIA EILEEN
Entity Type:Individual
Prefix:
First Name:MINDIA
Middle Name:EILEEN
Last Name:HAWTHORNE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:111 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-5363
Mailing Address - Country:US
Mailing Address - Phone:918-423-5204
Mailing Address - Fax:918-423-5255
Practice Address - Street 1:111 SOUTH MAIN STREET
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501
Practice Address - Country:US
Practice Address - Phone:918-423-5204
Practice Address - Fax:918-423-5255
Is Sole Proprietor?:Yes
Enumeration Date:2011-12-23
Last Update Date:2011-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health