Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 103TR0400X | Rehabilitation Psychologist | M213172039 | MO |
NPI | 1356692362 |
---|---|
Provider Name | Porcsha Sha'quell Herron |
First Address | Guthrie, OK 73044-5771 |
Second Address | Guthrie, OK 73044-5771 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 01/10/2012 |
Last Update Date | 01/10/2012 |