Provider Demographics
NPI:1891011102
Name:HAMMOND, BRUCE TODD (MBA)
Entity Type:Individual
Prefix:
First Name:BRUCE
Middle Name:TODD
Last Name:HAMMOND
Suffix:
Gender:M
Credentials:MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1606 SOUTHERN HILLS DR
Mailing Address - Street 2:
Mailing Address - City:ARDMORE
Mailing Address - State:OK
Mailing Address - Zip Code:73401-9065
Mailing Address - Country:US
Mailing Address - Phone:580-222-4037
Mailing Address - Fax:
Practice Address - Street 1:1606 SOUTHERN HILLS DR
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-9065
Practice Address - Country:US
Practice Address - Phone:580-222-4037
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-12
Last Update Date:2010-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKA080988522101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health