Provider Demographics
NPI:1821384769
Name:HARDEMAN, PAULA WILSON (M ED BHRS)
Entity Type:Individual
Prefix:MS
First Name:PAULA
Middle Name:WILSON
Last Name:HARDEMAN
Suffix:
Gender:F
Credentials:M ED BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6125 LYTLE DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73127-3820
Mailing Address - Country:US
Mailing Address - Phone:405-301-4481
Mailing Address - Fax:
Practice Address - Street 1:6125 LYTLE DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73127-3820
Practice Address - Country:US
Practice Address - Phone:405-301-4481
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-20
Last Update Date:2011-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKCERTIFICATE ODMHSAS101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health