Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 2176 | OK |
NPI | 1003039017 |
---|---|
Provider Name | Mr. Dan J Archer |
First Address | Edmond, OK 73013-6470 |
Second Address | Edmond, OK 73013-6470 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/04/2007 |
Last Update Date | 08/07/2007 |