Basic Information
| Provider Information | |||||||||
| NPI: | 1932319811 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | HARRINGTON | ||||||||
| FirstName: | AMANDA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | DR. | ||||||||
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| Credential: | LMFT | ||||||||
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| Mailing Information | |||||||||
| Address1: | CHICKASAW NATION MEDICAL CENTER | ||||||||
| Address2: | 1921 STONECIPHER BLVD. | ||||||||
| City: | ADA | ||||||||
| State: | OK | ||||||||
| PostalCode: | 74820 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5804363980 | ||||||||
| FaxNumber: | 5802725757 | ||||||||
| Practice Location | |||||||||
| Address1: | 1438 HARDCASTLE BLVD. | ||||||||
| Address2: | MEDICAL FAMILY THERAPY | ||||||||
| City: | PURCELL | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73080 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055274700 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 05/22/2007 | ||||||||
| LastUpdateDate: | 09/19/2018 | ||||||||
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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 | 106H00000X | 201101 | TX | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 106H00000X | 1052 | OK | Y | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.