Basic Information
Provider Information | |||||||||
NPI: | 1386689024 | ||||||||
EntityType: | 1 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: |   | ||||||||
LastName: | HACKNEY-ADKERSON | ||||||||
FirstName: | ANITA | ||||||||
MiddleName: | JO | ||||||||
NamePrefix: | MS. | ||||||||
NameSuffix: |   | ||||||||
Credential: | MCP, LPC | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: | HACKNEY | ||||||||
OtherFirstName: | ANITA | ||||||||
OtherMiddleName: | JO | ||||||||
OtherNamePrefix: | MS. | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: | MCP, LPC | ||||||||
OtherLastNameType: | 1 | ||||||||
Mailing Information | |||||||||
Address1: | 1801 COLLEEN DR | ||||||||
Address2: |   | ||||||||
City: | GUTHRIE | ||||||||
State: | OK | ||||||||
PostalCode: | 730446060 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4052824627 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 1025 STRAKA TER | ||||||||
Address2: |   | ||||||||
City: | OKLAHOMA CITY | ||||||||
State: | OK | ||||||||
PostalCode: | 731392544 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 4056326688 | ||||||||
FaxNumber: | 4056040923 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 06/17/2006 | ||||||||
LastUpdateDate: | 07/08/2007 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: | F | ||||||||
AuthorizedOfficialLastName: |   | ||||||||
AuthorizedOfficialFirstName: |   | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: |   | ||||||||
AuthorizedOfficialTelephone: |   | ||||||||
IsSoleProprietor: | X | ||||||||
IsOrganizationSubpart: |   | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: |   | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X |   |   | Y |   | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.