Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003131277 |
---|---|
Provider Name | Mr. Joseph Troy Proffer |
First Address | Oklahoma City, OK 73162-2543 |
Second Address | Oklahoma City, OK 73162-2543 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 31/03/2010 |
Last Update Date | 31/03/2010 |