| Doctor Name: | MS. MARY JACQUE ISHCOMER |
| NPI Number: | 1225152259 |
| Entity Type Code: | Individual (1) |
| Gender: | F |
| Credentials: | |
| License Number: | |
| Business Practice Address: | 2000 E Lincoln Rd Idabel, OK - 747457353 |
| Business Phone Number: | 5802866639 |
| Business Fax Number: | 5802865206 |
| Mailing Address: | 2000 E Lincoln Rd, IDABEL |
| State: | OK |
| Postal Code: | 747457353 |
| Phone Number: | 5802866639 |
| Fax Number: | 5802865206 |
| NPI Enumeration Date: | 03/16/2007 |
| NPI Last Update Date: | 07/08/2007 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 101YM0800X |
| License Number: | |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Counselor |
| Taxonomy Specialization: | Mental Health |
| Taxonomy Definition: | |