Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor |
NPI | 1003156571 |
---|---|
Provider Name | Paula Beard |
First Address | Valliant, OK 74764 |
Second Address | Valliant, OK 74764 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 21/02/2013 |
Last Update Date | 01/09/2016 |