Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YM0800X | Mental Health Counselor | ||
Y | 101YP1600X | Pastoral Counselor |
NPI | 1073925897 |
---|---|
Provider Name | Angela M Townsend |
First Address | Edmond, OK 73003-5737 |
Second Address | Edmond, OK 73003-5734 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 28/05/2014 |
Last Update Date | 20/06/2019 |