Doctor Name: | JESSE PIERCE |
NPI Number: | 1700195625 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | MS |
License Number: | |
Business Practice Address: | Rr 1, 35d Boley, OK - 74829 |
Business Phone Number: | 9186673367 |
Business Fax Number: | 9186673387 |
Mailing Address: | Po Box 218, BOLEY |
State: | OK |
Postal Code: | 748290218 |
Phone Number: | 9186673368 |
Fax Number: | 9186673387 |
NPI Enumeration Date: | 09/27/2010 |
NPI Last Update Date: | 08/19/2011 |
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: |