Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | OK | |
N | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1598001471 |
---|---|
Provider Name | Maribel Roy |
First Address | Poteau, OK 74953-0285 |
Second Address | Poteau, OK 74953-4224 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/12/2012 |
Last Update Date | 14/02/2013 |