Provider Demographics
NPI:1316291701
Name:NEIGHBORS, TINA ARLENE
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:ARLENE
Last Name:NEIGHBORS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1104 S NEPTUNE RD
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73003-6073
Mailing Address - Country:US
Mailing Address - Phone:405-328-0836
Mailing Address - Fax:405-789-2162
Practice Address - Street 1:1104 S NEPTUNE RD
Practice Address - Street 2:
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73003-6073
Practice Address - Country:US
Practice Address - Phone:405-328-0836
Practice Address - Fax:405-789-2162
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-06
Last Update Date:2012-11-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional