Provider Demographics
NPI:1457589194
Name:HARTLEY, EVA (LADC, LPC (US))
Entity Type:Individual
Prefix:MS
First Name:EVA
Middle Name:
Last Name:HARTLEY
Suffix:
Gender:F
Credentials:LADC, LPC (US)
Other - Prefix:MRS
Other - First Name:ETHEL
Other - Middle Name:EVA
Other - Last Name:HARTLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LADC, LPC (US)
Mailing Address - Street 1:P.O. BOX 216
Mailing Address - Street 2:
Mailing Address - City:WANETTE
Mailing Address - State:OK
Mailing Address - Zip Code:74878
Mailing Address - Country:US
Mailing Address - Phone:405-420-2469
Mailing Address - Fax:
Practice Address - Street 1:414 W MONROE ST
Practice Address - Street 2:
Practice Address - City:PURCELL
Practice Address - State:OK
Practice Address - Zip Code:73080-3208
Practice Address - Country:US
Practice Address - Phone:405-420-2469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-07-01
Last Update Date:2012-12-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK585101YA0400X
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health