Healthcare Provider Details

I. General information

NPI: 1669618807
Provider Name (Legal Business Name): JOSHUA BLAKE ENGLE
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/17/2008
Last Update Date: 02/14/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2320 N PERKINS RD
STILLWATER OK
74075-2203
US

IV. Provider business mailing address

2320 N PERKINS RD
STILLWATER OK
74075-2203
US

V. Phone/Fax

Practice location:
  • Phone: 405-743-3333
  • Fax:
Mailing address:
  • Phone: 405-743-3333
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: