Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 1252 | OK |
NPI | 1134452600 |
---|---|
Provider Name | Anna M Homen |
First Address | Moore, OK 73160-2405 |
Second Address | Moore, OK 73160-2405 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 15/09/2009 |
Last Update Date | 01/01/2016 |