Provider Demographics
NPI:1710123591
Name:PRICE, TOMMIE LEE (LADC)
Entity Type:Individual
Prefix:MR
First Name:TOMMIE
Middle Name:LEE
Last Name:PRICE
Suffix:
Gender:M
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 NE CIMARRON TRL
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73507-1433
Mailing Address - Country:US
Mailing Address - Phone:580-581-7272
Mailing Address - Fax:580-581-7272
Practice Address - Street 1:130 NE CIMARRON TRL
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73507-1433
Practice Address - Country:US
Practice Address - Phone:580-581-7272
Practice Address - Fax:580-581-7272
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-27
Last Update Date:2008-12-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK89101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor