Provider Demographics
NPI:1710007844
Name:HAMMACK, AMANDA DANIELLE (BS, BHRS, CMD)
Entity Type:Individual
Prefix:MS
First Name:AMANDA
Middle Name:DANIELLE
Last Name:HAMMACK
Suffix:
Gender:F
Credentials:BS, BHRS, CMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:421 E 15TH ST
Mailing Address - Street 2:
Mailing Address - City:ADA
Mailing Address - State:OK
Mailing Address - Zip Code:74820-6618
Mailing Address - Country:US
Mailing Address - Phone:580-332-6851
Mailing Address - Fax:580-310-6047
Practice Address - Street 1:931 ARLINGTON ST
Practice Address - Street 2:SUITE 2
Practice Address - City:ADA
Practice Address - State:OK
Practice Address - Zip Code:74820-4025
Practice Address - Country:US
Practice Address - Phone:580-332-6851
Practice Address - Fax:580-310-6047
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health