Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP1600X | Pastoral Counselor | 2871648 | OK |
Y | 104100000X | Social Worker |
NPI | 1225492440 |
---|---|
Provider Name | Sally Irvin |
First Address | Woodward, OK 73801-5442 |
Second Address | Woodward, OK 73801-5442 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/04/2016 |
Last Update Date | 13/04/2016 |