Provider Demographics
NPI:1790434710
Name:HANNAH KETCHUM LCSW PC
Entity Type:Organization
Organization Name:HANNAH KETCHUM LCSW PC
Other - Org Name:PRIORITY MENTAL HEALTH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LCSW
Authorized Official - Prefix:
Authorized Official - First Name:HANNAH
Authorized Official - Middle Name:
Authorized Official - Last Name:KETCHUM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-719-3324
Mailing Address - Street 1:5601 NW 72ND ST STE 112B
Mailing Address - Street 2:
Mailing Address - City:WARR ACRES
Mailing Address - State:OK
Mailing Address - Zip Code:73132-5931
Mailing Address - Country:US
Mailing Address - Phone:405-719-3324
Mailing Address - Fax:
Practice Address - Street 1:5601 NW 72ND ST STE 112B
Practice Address - Street 2:
Practice Address - City:WARR ACRES
Practice Address - State:OK
Practice Address - Zip Code:73132-5931
Practice Address - Country:US
Practice Address - Phone:405-719-3324
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-18
Last Update Date:2022-09-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)