Provider Demographics
NPI:1063299238
Name:MADKINS, TINA M
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:M
Last Name:MADKINS
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 1:301 W I 240 SERVICE RD
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73139-7701
Mailing Address - Country:US
Mailing Address - Phone:405-635-3831
Mailing Address - Fax:
Practice Address - Street 1:1100 N 102ND
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY OKLAHOMA
Practice Address - State:OK
Practice Address - Zip Code:73114
Practice Address - Country:US
Practice Address - Phone:405-675-1863
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-09-12
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No175T00000XOther Service ProvidersPeer Specialist