Doctor Name: | DAVID A TUMBLESON |
NPI Number: | 1750796314 |
Entity Type Code: | Individual (1) |
Gender: | M |
Credentials: | |
License Number: | |
Business Practice Address: | 300 N Dalton St Valliant, OK - 747648029 |
Business Phone Number: | 5809337031 |
Business Fax Number: | 5809337034 |
Mailing Address: | 300 N Dalton St, Po Box 673 VALLIANT |
State: | OK |
Postal Code: | 747648029 |
Phone Number: | 5809337031 |
Fax Number: | 5809337034 |
NPI Enumeration Date: | 06/23/2014 |
NPI Last Update Date: | 06/23/2014 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 101YM0800X |
License Number: | |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | OK |
Taxonomy Type: | Behavioral Health & Social Service Providers |
Taxonomy Classification: | Counselor |
Taxonomy Specialization: | Mental Health |
Taxonomy Definition: |