Provider Demographics
NPI:1972829901
Name:KOMAHCHEET, LISA DE AMBER (LADC)
Entity Type:Individual
Prefix:MS
First Name:LISA
Middle Name:DE AMBER
Last Name:KOMAHCHEET
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:
Other - Last Name:KOMAHCHEET
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LADC
Mailing Address - Street 1:3212 SW 104TH TER
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73159-7800
Mailing Address - Country:US
Mailing Address - Phone:405-213-3700
Mailing Address - Fax:405-208-4574
Practice Address - Street 1:3212 SW 104TH TER
Practice Address - Street 2:2915 N CLASSEN BLVD. SUITE 325
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73159-7800
Practice Address - Country:US
Practice Address - Phone:405-213-3700
Practice Address - Fax:405-208-4574
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-15
Last Update Date:2010-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK#588101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor