Provider Demographics
NPI:1669604575
Name:HEMME, ELIZABETH A (MCP, LADC-MH)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:HEMME
Suffix:
Gender:F
Credentials:MCP, LADC-MH
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:
Other - Last Name:HEMME
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MCP, LADC-MH
Mailing Address - Street 1:1327 S 8TH ST
Mailing Address - Street 2:
Mailing Address - City:KINGFISHER
Mailing Address - State:OK
Mailing Address - Zip Code:73750-4205
Mailing Address - Country:US
Mailing Address - Phone:405-538-6407
Mailing Address - Fax:
Practice Address - Street 1:208 N MAIN ST
Practice Address - Street 2:
Practice Address - City:KINGFISHER
Practice Address - State:OK
Practice Address - Zip Code:73750-2739
Practice Address - Country:US
Practice Address - Phone:405-538-6407
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2016-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
OK1199101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200584240AMedicaid
OK200584240AMedicaid