Basic Information
| Provider Information | |||||||||
| NPI: | 1215209606 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | LAMAY | ||||||||
| FirstName: | EDITH | ||||||||
| MiddleName: | A. | ||||||||
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| Credential: | MS | ||||||||
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| Mailing Information | |||||||||
| Address1: | 5110 S YALE AVE STE 103 | ||||||||
| Address2: | |||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741357455 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187797637 | ||||||||
| FaxNumber: | 9189386037 | ||||||||
| Practice Location | |||||||||
| Address1: | 5110 S YALE AVE | ||||||||
| Address2: | STE 103 | ||||||||
| City: | TULSA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 741357401 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187797637 | ||||||||
| FaxNumber: | 9189386037 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 02/01/2012 | ||||||||
| LastUpdateDate: | 02/01/2012 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | OK | Y | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent |
ID Information
| ID | Type | State | Issuer | Description | 113796324 | 05 | OK | MEDICAID |