Provider Demographics
NPI:1023244944
Name:FIFE, THOMASINE L (LADC)
Entity type:Individual
Prefix:MRS
First Name:THOMASINE
Middle Name:L
Last Name:FIFE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 W 7TH ST STE 102
Mailing Address - Street 2:
Mailing Address - City:OKMULGEE
Mailing Address - State:OK
Mailing Address - Zip Code:74447-5007
Mailing Address - Country:US
Mailing Address - Phone:918-758-1930
Mailing Address - Fax:
Practice Address - Street 1:100 W 7TH ST STE 102
Practice Address - Street 2:
Practice Address - City:OKMULGEE
Practice Address - State:OK
Practice Address - Zip Code:74447-5007
Practice Address - Country:US
Practice Address - Phone:918-758-1930
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-06-05
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK300522336OtherMEDICARE