Healthcare Provider Details

I. General information

NPI: 1578437620
Provider Name (Legal Business Name): TERESA ANN NORIE PASTOR
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/01/2025
Last Update Date: 10/01/2025
Certification Date: 10/01/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

431 WORTH AVE
DURANT OK
74701-4179
US

IV. Provider business mailing address

431 WORTH AVE
DURANT OK
74701-4179
US

V. Phone/Fax

Practice location:
  • Phone: 940-999-4839
  • Fax:
Mailing address:
  • Phone: 940-999-4839
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number602099
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: