Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003074287 |
---|---|
Provider Name | Mr. Daren Hildreth |
First Address | Tulsa, OK 74110-1144 |
Second Address | Tulsa, OK 74110-1144 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 25/05/2008 |
Last Update Date | 25/05/2008 |