Doctor Name: | BOBBY JOE BILLUPS |
NPI Number: | 1275859175 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | BS |
License Number: | |
Business Practice Address: | 118 S Main St Wagoner, OK - 744675221 |
Business Phone Number: | 9184851573 |
Business Fax Number: | 9184851575 |
Mailing Address: | 118 S Main St, WAGONER |
State: | OK |
Postal Code: | 744675221 |
Phone Number: | 9184851573 |
Fax Number: | 9184851575 |
NPI Enumeration Date: | 04/16/2010 |
NPI Last Update Date: | 04/16/2010 |
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: |