| Organization Name: | MAYES COUNTY SPEECH THERAPY SERVICES P.L.L.C. |
| NPI Number: | 1033248356 |
| Entity Type Code: | Organizational (2) |
| Authorized Official Name: | TINA MICHELL VAN HORN (SPEECH LANGUAGE PATHOLOGIST -OWNER) |
| Mailing Address: | 510 S Elliott St Pryor |
| State: | OK US |
| Postal Code: | 743616411 |
| Phone Number: | 9188254837 |
| Fax Number: | |
| NPI Enumeration Date: | 03/04/2007 |
| NPI Last Update Date: | 12/07/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 235Z00000X |
| License Number: | 3168 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | OK |
| Taxonomy Type: | Speech, Language and Hearing Service Providers |
| Taxonomy Classification: | Speech-Language Pathologist |
| Taxonomy Specialization: | |
| Taxonomy Definition: | A speech pathologist is a person qualified by a master |