Provider Demographics
NPI:1134452600
Name:HOMEN, ANNA M (PHD)
Entity type:Individual
Prefix:
First Name:ANNA
Middle Name:M
Last Name:HOMEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:ANNA
Other - Middle Name:M
Other - Last Name:DEMARTINI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1044 SW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:MOORE
Mailing Address - State:OK
Mailing Address - Zip Code:73160-2405
Mailing Address - Country:US
Mailing Address - Phone:405-735-6333
Mailing Address - Fax:405-735-6629
Practice Address - Street 1:1044 SW 4TH ST
Practice Address - Street 2:
Practice Address - City:MOORE
Practice Address - State:OK
Practice Address - Zip Code:73160-2405
Practice Address - Country:US
Practice Address - Phone:405-735-6333
Practice Address - Fax:405-735-6629
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-15
Last Update Date:2016-01-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1252103TC2200X
390200000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent