Provider Demographics
NPI:1912347337
Name:RETHERFORD, AMY M
Entity Type:Individual
Prefix:MRS
First Name:AMY
Middle Name:M
Last Name:RETHERFORD
Suffix:
Gender:F
Credentials:
Other - Prefix:MS
Other - First Name:AMY
Other - Middle Name:M
Other - Last Name:ST.JOHN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:15108 VICKI DR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73170-7518
Mailing Address - Country:US
Mailing Address - Phone:405-802-1547
Mailing Address - Fax:
Practice Address - Street 1:15108 VICKI DR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73170-7518
Practice Address - Country:US
Practice Address - Phone:405-802-1547
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-29
Last Update Date:2013-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health