Doctor Name: | THERESA R PAGE-BOHANNAN |
NPI Number: | 1023238227 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | 1975 |
Business Practice Address: | 414 E 3rd St Ste D Grove, OK - 743447130 |
Business Phone Number: | 9187864331 |
Business Fax Number: | 9187864332 |
Mailing Address: | 414 E 3rd St Ste D, GROVE |
State: | OK |
Postal Code: | 743447130 |
Phone Number: | 9187864331 |
Fax Number: | 9187864332 |
NPI Enumeration Date: | 04/27/2007 |
NPI Last Update Date: | 07/29/2008 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | 1975 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |