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NPI Code Detail

MEDICARE: COQUESTIA DIXON MHR

MEDICARE: COQUESTIA DIXON MHR
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1538436597
Entity Type Code : Individual
Provider Name (Legal Business Name) : COQUESTIA DIXON MHR
Provider Business Mailing Address
First Line : 2625 N PEORIA AVE
Second Line :
City : TULSA
State : OK
Zip : 74106-2512
Country : US
Telephone Number : 918-794-0196
Fax Number : 918-794-0196
Provider Business Practice Location Address
First Line : 2625 N PEORIA AVE
Second Line :
City : TULSA
State : OK
Zip : 74106-2512
Country : US
Telephone Number : 918-794-0196
Fax Number : 918-794-0196
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 11/18/2011
Last Update Date : 11/18/2011

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