Provider Demographics
NPI:1134341274
Name:VAIL, TAMMIE RACHELE (BA-CM-A)
Entity type:Individual
Prefix:MRS
First Name:TAMMIE
Middle Name:RACHELE
Last Name:VAIL
Suffix:
Gender:F
Credentials:BA-CM-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 S ENGLISH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-7107
Mailing Address - Country:US
Mailing Address - Phone:405-245-2475
Mailing Address - Fax:405-522-8661
Practice Address - Street 1:4436 NW 50TH ST
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-2212
Practice Address - Country:US
Practice Address - Phone:405-272-0660
Practice Address - Fax:405-272-4785
Is Sole Proprietor?:No
Enumeration Date:2007-05-02
Last Update Date:2012-10-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK9412101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor