Basic Information
| Provider Information | |||||||||
| NPI: | 1710007844 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | HAMMACK | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | DANIELLE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BS, BHRS, CMD | ||||||||
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| Mailing Information | |||||||||
| Address1: | 421 E 15TH ST | ||||||||
| Address2: | |||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748206618 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803326851 | ||||||||
| FaxNumber: | 5803106047 | ||||||||
| Practice Location | |||||||||
| Address1: | 931 ARLINGTON ST | ||||||||
| Address2: | SUITE 2 | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 748204025 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5803326851 | ||||||||
| FaxNumber: | 5803106047 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/30/2007 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.