Doctor Name: | JILL MAREE BASHORUN |
NPI Number: | 1023262771 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 800 Birch Street Wellston, OK - 74881 |
Business Phone Number: | 4053562533 |
Business Fax Number: | 4053562838 |
Mailing Address: | Po Box 492, WELLSTON |
State: | OK |
Postal Code: | 748810492 |
Phone Number: | 4056507278 |
Fax Number: | |
NPI Enumeration Date: | 11/07/2008 |
NPI Last Update Date: | 02/03/2009 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |