Provider Demographics
NPI:1336387315
Name:HAILU, TENAYE (LMFT)
Entity Type:Individual
Prefix:PROF
First Name:TENAYE
Middle Name:
Last Name:HAILU
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:PROF
Other - First Name:TENAYE
Other - Middle Name:HAILU
Other - Last Name:BAISSA
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LMFT
Mailing Address - Street 1:7633 E 63RD PL STE 300
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-1202
Mailing Address - Country:US
Mailing Address - Phone:918-740-6195
Mailing Address - Fax:
Practice Address - Street 1:7633 E 63RD PL STE 300
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-1202
Practice Address - Country:US
Practice Address - Phone:918-740-6195
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-28
Last Update Date:2020-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1096106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1096OtherLMFT