Doctor Name: | REBECCA WISENER |
NPI Number: | 1205052677 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | LPC 1638 |
Business Practice Address: | 1923 S. Division Guthrie, OK - 73044 |
Business Phone Number: | 4052821830 |
Business Fax Number: | 4052821861 |
Mailing Address: | 1222 10th St Ste 211, WOODWARD |
State: | OK |
Postal Code: | 738013156 |
Phone Number: | 4052821830 |
Fax Number: | 4052821861 |
NPI Enumeration Date: | 04/17/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | LPC 1638 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |