Healthcare Provider Details

I. General information

NPI: 1114167558
Provider Name (Legal Business Name): WELLSTON PUBLIC SCHOOLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 02/25/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 BIRCH STREET
WELLSTON OK
74881
US

IV. Provider business mailing address

800 BIRCH STREET PO BOX 60
WELLSTON OK
74881
US

V. Phone/Fax

Practice location:
  • Phone: 405-356-2533
  • Fax: 405-356-2838
Mailing address:
  • Phone: 405-356-2533
  • Fax: 405-356-2838

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: JILL M BASHORUN
Title or Position: THERAPIST
Credential: LPC
Phone: 405-356-2533