Doctor Name: | CRYSTAL RENEE TOLAND |
NPI Number: | 1841692019 |
Entity Type Code: | Individual (1) |
Gender: | F |
Credentials: | |
License Number: | |
Business Practice Address: | 2856 Nw 1050th Ave Wilburton, OK - 745786626 |
Business Phone Number: | 9184710417 |
Business Fax Number: | |
Mailing Address: | 2856 Nw 1050th Ave, WILBURTON |
State: | OK |
Postal Code: | 745786626 |
Phone Number: | 9184710417 |
Fax Number: | |
NPI Enumeration Date: | 09/19/2014 |
NPI Last Update Date: | 09/19/2014 |
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: |