Healthcare Provider Details

I. General information

NPI: 1508902925
Provider Name (Legal Business Name): ARLENE MARY CRESWELL M.H.R.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2007
Last Update Date: 07/03/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

501 E 15TH ST SUITE 102
EDMOND OK
73013-5043
US

IV. Provider business mailing address

501 E 15TH ST SUITE 102
EDMOND OK
73013-5043
US

V. Phone/Fax

Practice location:
  • Phone: 405-285-9880
  • Fax: 405-285-9877
Mailing address:
  • Phone: 405-285-9880
  • Fax: 405-285-9877

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC3222
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: