Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 101YP2500X | Professional Counselor | 4042 | OK |
N | 101YS0200X | School Counselor |
NPI | 1083850564 |
---|---|
Provider Name | Tessa Jane Craig |
First Address | Lawton, OK 73507-5956 |
Second Address | Lawton, OK 73501-7305 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 05/01/2009 |
Last Update Date | 05/01/2009 |