Provider Demographics
NPI:1447474812
Name:HALLMAN, MALISA (MBS,LBP)
Entity type:Individual
Prefix:
First Name:MALISA
Middle Name:
Last Name:HALLMAN
Suffix:
Gender:F
Credentials:MBS,LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 542
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-0542
Mailing Address - Country:US
Mailing Address - Phone:580-271-1638
Mailing Address - Fax:
Practice Address - Street 1:301 N HIGH ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-2238
Practice Address - Country:US
Practice Address - Phone:580-271-7055
Practice Address - Fax:580-271-7056
Is Sole Proprietor?:Yes
Enumeration Date:2007-04-13
Last Update Date:2021-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
OK0340101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor