Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | ||
N | 103TH0004X | Health Psychologist | ||
N | 103TR0400X | Rehabilitation Psychologist |
NPI | 1306151451 |
---|---|
Provider Name | Victoria S Waldrup |
First Address | Broken Arrow, OK 74012-7950 |
Second Address | Claremore, OK 74017-4294 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 13/08/2010 |
Last Update Date | 13/08/2010 |