Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003242322 |
---|---|
Provider Name | Ruth Sellers |
First Address | Stilwell, OK 74960-3100 |
Second Address | Stilwell, OK 74960-3100 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 18/09/2013 |
Last Update Date | 18/09/2013 |