Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003119082 |
---|---|
Provider Name | Ms. Lori Leann Boehme |
First Address | Caney, OK 74533 |
Second Address | Caney, OK 74533 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 13/12/2010 |
Last Update Date | 13/12/2010 |