Healthcare Provider Details

I. General information

NPI: 1649521485
Provider Name (Legal Business Name): DUSHARME LLANUSA MLA
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2012
Last Update Date: 09/19/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

299 S TRIPLE X RD
CHOCTAW OK
73020-6911
US

IV. Provider business mailing address

299 S TRIPLE X RD
CHOCTAW OK
73020-6911
US

V. Phone/Fax

Practice location:
  • Phone: 405-620-5537
  • Fax:
Mailing address:
  • Phone: 405-620-5537
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: