Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TR0400X | Rehabilitation Psychologist | OK |
NPI | 1205167020 |
---|---|
Provider Name | Tina Mcbride |
First Address | Red Oak, OK 74563-2352 |
Second Address | Red Oak, OK 74563-2352 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 18/01/2010 |
Last Update Date | 22/05/2013 |