| NPI | 1801218466 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | ROBERT WAYNE WAGNER Counselor 405-606-8886 |
| Organization Subpart ? | No |
| Primary Taxonomy | 251S00000X (Licence: OK 476) |
| Additional Taxonomies | 171M00000X Case Manager/Care Coordinator (Licence: OK 412) |
| Enumeration Date | 2014-01-15 |
| Last Update Date | 2014-01-15 |