Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 3490 | OK |
Y | 101YP2500X | Professional Counselor | 3490 | OK |
NPI | 1003052465 |
---|---|
Provider Name | Leslie Lynn Crow |
First Address | Okmulgee, OK 74447-5007 |
Second Address | Okmulgee, OK 74447-5007 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 06/01/2009 |
Last Update Date | 14/12/2010 |