Healthcare Provider Details

I. General information

NPI: 1861765372
Provider Name (Legal Business Name): PAMELA K SANDERS BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/14/2012
Last Update Date: 02/14/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

705 W 13TH ST
ATOKA OK
74525-3712
US

IV. Provider business mailing address

17083 CR 3699
ALLEN OK
74825
US

V. Phone/Fax

Practice location:
  • Phone: 580-889-5555
  • Fax: 580-889-1925
Mailing address:
  • Phone: 580-265-9223
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: