Organization Name: | DISCOVERY UTTUWAH LLC |
NPI Number: | 1427175363 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUE BILLUPS (OWNER COUNSELOR) |
Mailing Address: | 118 S Main St Wagoner |
State: | OK US |
Postal Code: | 744675221 |
Phone Number: | 9184851573 |
Fax Number: | 9184851575 |
NPI Enumeration Date: | 03/24/2007 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | 2620 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |