Healthcare Provider Details

I. General information

NPI: 1285757823
Provider Name (Legal Business Name): DAVID RAY SAWYER EDD, LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 2ND AVE SW
MIAMI OK
74354-6818
US

IV. Provider business mailing address

27375 S 4520 RD
AFTON OK
74331-6179
US

V. Phone/Fax

Practice location:
  • Phone: 918-540-7458
  • Fax: 918-540-7745
Mailing address:
  • Phone: 918-540-7458
  • Fax: 918-540-7745

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1020
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: