Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist |
NPI | 1477823003 |
---|---|
Provider Name | Mrs. Ariana Mcgough |
First Address | Marlow, OK 73055-9021 |
Second Address | Marlow, OK 73055-9021 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 12/01/2012 |
Last Update Date | 12/01/2012 |