Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YA0400X | Addiction Counselor (Substance Use Disorder) | 773 | OK |
Y | 101YM0800X | Mental Health Counselor | 4323 | OK |
NPI | 1003037565 |
---|---|
Provider Name | Mr. William Thomas Mosher |
First Address | Skiatook, OK 74070-5501 |
Second Address | Nowata, OK 74048-2601 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/05/2007 |
Last Update Date | 14/03/2012 |