Healthcare Provider Details

I. General information

NPI: 1336425156
Provider Name (Legal Business Name): GEINA A MOTLEY BHRS
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/25/2011
Last Update Date: 10/25/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

RT 2 BOX 1542
CHECOTAH OK
74426
US

IV. Provider business mailing address

PO BOX 214
CROWDER OK
74430-0214
US

V. Phone/Fax

Practice location:
  • Phone: 918-689-7416
  • Fax: 918-689-7429
Mailing address:
  • Phone: 918-429-7698
  • 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: