MEDICARE: MS. CALETTA MCPHERSON MHR, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	433	OK

General Provider Information

NPI Number	:	1497959878
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CALETTA MCPHERSON MHR, LADC

Provider Business Mailing Address
First Line	:	3621 N KELLEY AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-4520
Country	:	US
Telephone Number	:	405-524-5525
Fax Number	:	405-524-5528

Provider Business Practice Location Address
First Line	:	3621 N KELLEY AVE
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73111-4520
Country	:	US
Telephone Number	:	405-524-5525
Fax Number	:	405-524-5528

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/12/2007
Last Update Date	:	07/08/2007

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