Doctor Name: | MS. WANDA SUE MANOS |
NPI Number: | 1578726444 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | LPC |
License Number: | |
Business Practice Address: | 209 W Broadway St Okemah, OK - 748592618 |
Business Phone Number: | 9188232922 |
Business Fax Number: | |
Mailing Address: | 1200 W 4th St, Suite D TAHLEQUAH |
State: | OK |
Postal Code: | 744645013 |
Phone Number: | 9184580113 |
Fax Number: | |
NPI Enumeration Date: | 07/09/2008 |
NPI Last Update Date: | 03/27/2012 |
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: |