Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101Y00000X | Counselor |
NPI | 1003011453 |
---|---|
Provider Name | Sallie Jane Dominey |
First Address | Oklahoma City, OK 73112-2212 |
Second Address | Lawton, OK 73501-4619 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 17/06/2007 |
Last Update Date | 08/07/2007 |