Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YP2500X | Professional Counselor | 2731 | OK |
NPI | 1003108044 |
---|---|
Provider Name | Lonnie Roy Manuel |
First Address | Ada, OK 74820 |
Second Address | Ada, OK 74820 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 10/05/2011 |
Last Update Date | 16/11/2016 |