Doctor Name: | TERRAH LYNN MANES |
NPI Number: | 1043415474 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LCSW |
License Number: | |
Business Practice Address: | 711 S Muskogee Ave Tahlequah, OK - 744644717 |
Business Phone Number: | 9182070078 |
Business Fax Number: | 9182070558 |
Mailing Address: | 19393 W 846 Rd, PARK HILL |
State: | OK |
Postal Code: | 744512014 |
Phone Number: | 9188691984 |
Fax Number: | |
NPI Enumeration Date: | 06/16/2007 |
NPI Last Update Date: | 08/12/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |