Doctor Name: | MRS. ELIZABETH JADE EASON |
NPI Number: | 1295093706 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | 261Q00000X |
Business Practice Address: | 201 S Murray St Tishomingo, OK - 734602224 |
Business Phone Number: | 5803710321 |
Business Fax Number: | 5803710131 |
Mailing Address: | 201 S Murray St, TISHOMINGO |
State: | OK |
Postal Code: | 734602224 |
Phone Number: | 5803710321 |
Fax Number: | 5803710131 |
NPI Enumeration Date: | 05/03/2012 |
NPI Last Update Date: | 05/03/2012 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 261Q00000X |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |