Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003062712 |
---|---|
Provider Name | James Stilley |
First Address | Woodward, OK 73801-3156 |
Second Address | Enid, OK 73701-3221 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2008 |
Last Update Date | 13/08/2008 |