Provider Demographics
NPI:1588632749
Name:CROWN, TAMMI D (LCSW)
Entity Type:Individual
Prefix:
First Name:TAMMI
Middle Name:D
Last Name:CROWN
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 SOUTHERN HILL
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73072-8547
Mailing Address - Country:US
Mailing Address - Phone:405-630-0189
Mailing Address - Fax:405-840-3794
Practice Address - Street 1:1200 SOUTHERN HILLS CIR
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072
Practice Address - Country:US
Practice Address - Phone:405-630-0189
Practice Address - Fax:405-872-0680
Is Sole Proprietor?:Yes
Enumeration Date:2006-03-14
Last Update Date:2016-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK15951041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100640940CMedicaid
OK100640940CMedicaid