Healthcare Provider Details

I. General information

NPI: 1427224831
Provider Name (Legal Business Name): SEAN CHRISTOPHER WAGGONER BA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

900 E MAIN ST
NORMAN OK
73071-5305
US

IV. Provider business mailing address

900 E MAIN ST
NORMAN OK
73071-5305
US

V. Phone/Fax

Practice location:
  • Phone: 405-573-6466
  • Fax:
Mailing address:
  • Phone: 405-573-6466
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: