Doctor Name: | JOHN WENSLER |
NPI Number: | 1073934980 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | RSS |
License Number: | |
Business Practice Address: | 620 W Grand Ave Ponca City, OK - 746015123 |
Business Phone Number: | 5807621462 |
Business Fax Number: | 5807657299 |
Mailing Address: | 620 W Grand Ave, PONCA CITY |
State: | OK |
Postal Code: | 746015123 |
Phone Number: | 5807621462 |
Fax Number: | 5807657299 |
NPI Enumeration Date: | 12/18/2013 |
NPI Last Update Date: | 12/18/2013 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YA0400X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Addiction (Substance Use Disorder) |
Taxonomy Definition: |