Provider Demographics
NPI:1639621840
Name:HOOGERHYDE, MARY
Entity Type:Individual
Prefix:
First Name:MARY
Middle Name:
Last Name:HOOGERHYDE
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 1:213 S WALNUT ST
Mailing Address - Street 2:
Mailing Address - City:PADEN
Mailing Address - State:OK
Mailing Address - Zip Code:74860-9260
Mailing Address - Country:US
Mailing Address - Phone:405-932-1293
Mailing Address - Fax:
Practice Address - Street 1:213 S WALNUT ST
Practice Address - Street 2:
Practice Address - City:PADEN
Practice Address - State:OK
Practice Address - Zip Code:74860-9260
Practice Address - Country:US
Practice Address - Phone:405-932-1293
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-11-04
Last Update Date:2016-11-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
No175T00000XOther Service ProvidersPeer Specialist