Doctor Name: | EVALLISON EDDY |
NPI Number: | 1457663759 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 231 E Graham Ave Pryor, OK - 743612436 |
Business Phone Number: | 9188251405 |
Business Fax Number: | 9188251406 |
Mailing Address: | 231 E Graham Ave, PRYOR |
State: | OK |
Postal Code: | 743612436 |
Phone Number: | 9188251405 |
Fax Number: | 9188251406 |
NPI Enumeration Date: | 07/02/2010 |
NPI Last Update Date: | 03/18/2016 |
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: |