Provider Demographics
NPI:1770829871
Name:MACEDO, PAM HAYNES (MED)
Entity Type:Individual
Prefix:
First Name:PAM
Middle Name:HAYNES
Last Name:MACEDO
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:716 S CAPITOL ST
Mailing Address - Street 2:
Mailing Address - City:GUTHRIE
Mailing Address - State:OK
Mailing Address - Zip Code:73044-5308
Mailing Address - Country:US
Mailing Address - Phone:405-990-1761
Mailing Address - Fax:405-241-7038
Practice Address - Street 1:716 S CAPITOL ST
Practice Address - Street 2:
Practice Address - City:GUTHRIE
Practice Address - State:OK
Practice Address - Zip Code:73044-5308
Practice Address - Country:US
Practice Address - Phone:405-990-1761
Practice Address - Fax:405-241-7038
Is Sole Proprietor?:Yes
Enumeration Date:2012-12-17
Last Update Date:2012-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional