Provider Demographics
NPI:1750596805
Name:TAN, KAY M (MHR, LPC)
Entity type:Individual
Prefix:
First Name:KAY
Middle Name:M
Last Name:TAN
Suffix:
Gender:F
Credentials:MHR, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7409 S BIRMINGHAM CT
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74136-5512
Mailing Address - Country:US
Mailing Address - Phone:405-360-2133
Mailing Address - Fax:405-360-2252
Practice Address - Street 1:2303 S YORK ST
Practice Address - Street 2:
Practice Address - City:MUSKOGEE
Practice Address - State:OK
Practice Address - Zip Code:74403-8876
Practice Address - Country:US
Practice Address - Phone:918-686-5588
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2756103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling