Provider Demographics
NPI:1619280757
Name:HEIDI J H KAMM, PH.D., PLLC
Entity Type:Organization
Organization Name:HEIDI J H KAMM, PH.D., PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:HEIDI
Authorized Official - Middle Name:J
Authorized Official - Last Name:KAMM
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-292-1000
Mailing Address - Street 1:1225 W MAIN ST
Mailing Address - Street 2:STE 102
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73069-6824
Mailing Address - Country:US
Mailing Address - Phone:405-292-1000
Mailing Address - Fax:405-801-2506
Practice Address - Street 1:1225 W MAIN ST
Practice Address - Street 2:STE 102
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73069-6824
Practice Address - Country:US
Practice Address - Phone:405-292-1000
Practice Address - Fax:405-801-2506
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-19
Last Update Date:2010-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Single Specialty