Healthcare Provider Details

I. General information

NPI: 1518298439
Provider Name (Legal Business Name): WINFRED CRAIG BELCHER LPC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/15/2010
Last Update Date: 01/15/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1012 E BELCHER LN
TAHLEQUAH OK
74464-6754
US

IV. Provider business mailing address

1012 E BELCHER LN
TAHLEQUAH OK
74464-6754
US

V. Phone/Fax

Practice location:
  • Phone: 918-822-0814
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC 2041
License Number StateOK

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: