Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TC1900X | Counseling Psychologist | 1218 | OK |
NPI | 1013110451 |
---|---|
Provider Name | Mrs. Elisabeth Ann Pasco-Burke |
First Address | Tulsa, OK 74135-2311 |
Second Address | Tulsa, OK 74136-5743 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 05/06/2007 |
Last Update Date | 08/07/2007 |