Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 225C00000X | Rehabilitation Counselor |
NPI | 1245509769 |
---|---|
Provider Name | Justin B Hawkinson |
First Address | Yukon, OK 73099-5129 |
Second Address | Yukon, OK 73099-5129 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 29/12/2011 |
Last Update Date | 29/12/2011 |