Provider Demographics
NPI:1679105068
Name:HALFACRE, AUDREY JUNE (BS, MHA)
Entity Type:Individual
Prefix:
First Name:AUDREY
Middle Name:JUNE
Last Name:HALFACRE
Suffix:
Gender:F
Credentials:BS, MHA
Other - Prefix:
Other - First Name:AUDREY
Other - Middle Name:JUNE
Other - Last Name:MAHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:BS, MHA
Mailing Address - Street 1:4803 RIDGE ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-5644
Mailing Address - Country:US
Mailing Address - Phone:918-316-0130
Mailing Address - Fax:
Practice Address - Street 1:4803 RIDGE ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-5644
Practice Address - Country:US
Practice Address - Phone:918-316-0130
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-04
Last Update Date:2021-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)