Healthcare Provider Details

I. General information

NPI: 1538223540
Provider Name (Legal Business Name): SHERMAN RAY NOFIRE L.P.C.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/21/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

27753 S WELLING RD
WELLING OK
74471-2202
US

IV. Provider business mailing address

24304 EAST 831 RD
WELLING OK
74471
US

V. Phone/Fax

Practice location:
  • Phone: 918-457-4999
  • Fax:
Mailing address:
  • Phone: 918-456-5848
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number2181
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: