Healthcare Provider Details

I. General information

NPI: 1912566902
Provider Name (Legal Business Name): HEATHER WESBERRY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/12/2019
Last Update Date: 06/16/2026
Certification Date: 06/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 S WASHITA AVE
WYNNEWOOD OK
73098-7820
US

IV. Provider business mailing address

701 S 3RD ST
DAVIS OK
73030-3116
US

V. Phone/Fax

Practice location:
  • Phone: 405-665-4385
  • Fax:
Mailing address:
  • Phone: 580-340-6583
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: