Doctor Name: | LONNIE ROY MANUEL |
NPI Number: | 1003108044 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | L.P.C. |
License Number: | 2731 |
Business Practice Address: | 231 Seabrook Rd Ada, OK - 748201006 |
Business Phone Number: | 5804361222 |
Business Fax Number: | 5804361333 |
Mailing Address: | 231 Seabrook Rd, ADA |
State: | OK |
Postal Code: | 748201006 |
Phone Number: | 5804361222 |
Fax Number: | 5804361333 |
NPI Enumeration Date: | 05/10/2011 |
NPI Last Update Date: | 05/10/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 2731 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |