Doctor Name: | WANA R. ELLISON |
NPI Number: | 1245567890 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 7777 E. Hwy 66 El Reno, OK - 73036 |
Business Phone Number: | 4056513591 |
Business Fax Number: | |
Mailing Address: | 7777 E. Hwy 66, EL RENO |
State: | OK |
Postal Code: | 73036 |
Phone Number: | 4056513591 |
Fax Number: | |
NPI Enumeration Date: | 11/03/2009 |
NPI Last Update Date: | 10/19/2011 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YP2500X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Professional |
Taxonomy Definition: |