Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003118258 |
---|---|
Provider Name | Ms. Lisa Laverne Reich |
First Address | Mcalester, OK 74501-3929 |
Second Address | Mcalester, OK 74501-3929 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 20/11/2010 |
Last Update Date | 29/01/2016 |
IDENTIFIER | TYPE / CODE | IDENTIFIER STATE |
---|---|---|
200359380 A | (05) | OK |