Provider Demographics
NPI:1952681645
Name:HAMMONS, JUSTIN (MS, LMFT)
Entity Type:Individual
Prefix:
First Name:JUSTIN
Middle Name:
Last Name:HAMMONS
Suffix:
Gender:M
Credentials:MS, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1390 S DOUGLAS BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73130-5271
Mailing Address - Country:US
Mailing Address - Phone:405-679-4977
Mailing Address - Fax:
Practice Address - Street 1:1390 S DOUGLAS BLVD STE 102
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73130-5271
Practice Address - Country:US
Practice Address - Phone:405-679-4977
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-25
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171M00000X
OK1348106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1659685402Medicaid