Provider Demographics
NPI:1265727234
Name:MAYDEN, TAMMY LYNN (MS)
Entity type:Individual
Prefix:
First Name:TAMMY
Middle Name:LYNN
Last Name:MAYDEN
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:225 N 3RD ST
Mailing Address - Street 2:P.O. BOX 663
Mailing Address - City:BLACKWELL
Mailing Address - State:OK
Mailing Address - Zip Code:74631-2138
Mailing Address - Country:US
Mailing Address - Phone:580-363-7509
Mailing Address - Fax:
Practice Address - Street 1:225 N 3RD ST
Practice Address - Street 2:
Practice Address - City:BLACKWELL
Practice Address - State:OK
Practice Address - Zip Code:74631-2138
Practice Address - Country:US
Practice Address - Phone:580-363-7509
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-06-17
Last Update Date:2011-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor