Healthcare Provider Details

I. General information

NPI: 1225288863
Provider Name (Legal Business Name): GEORGE WAYNE DURRENCE MBS, LBP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/19/2008
Last Update Date: 04/25/2026
Certification Date: 04/25/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

104 N 4TH ST
HUGO OK
74743-4003
US

IV. Provider business mailing address

304 SW C ST
ANTLERS OK
74523-3849
US

V. Phone/Fax

Practice location:
  • Phone: 580-326-9289
  • Fax: 580-326-9283
Mailing address:
  • Phone: 580-298-3846
  • Fax: 580-298-3847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number0338
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: