Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YS0200X | School Counselor | 155616 | OK |
NPI | 1053726711 |
---|---|
Provider Name | Mr. Robert Evans JR. |
First Address | Edmond, OK 73012-6730 |
Second Address | Edmond, OK 73012-6730 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 20/06/2014 |
Last Update Date | 20/06/2014 |