Provider Demographics
NPI:1154537272
Name:TRAMMEL, CYNTHIA (MHR, BS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:TRAMMEL
Suffix:
Gender:F
Credentials:MHR, BS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:307 W GALER AVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048-4235
Mailing Address - Country:US
Mailing Address - Phone:918-273-2525
Mailing Address - Fax:
Practice Address - Street 1:307 W GALER AVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048-4235
Practice Address - Country:US
Practice Address - Phone:918-273-2525
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKPENDINGOOO101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)