Provider Demographics
NPI:1760880272
Name:HART, AMBER NICHOLE (MS LPC)
Entity Type:Individual
Prefix:MRS
First Name:AMBER
Middle Name:NICHOLE
Last Name:HART
Suffix:
Gender:F
Credentials:MS LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:401 DEERTAIL DR
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-5526
Mailing Address - Country:US
Mailing Address - Phone:918-413-2291
Mailing Address - Fax:
Practice Address - Street 1:401 DEERTAIL DR
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-5526
Practice Address - Country:US
Practice Address - Phone:918-413-2291
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2019-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK2QM00000XMedicaid