Healthcare Provider Details

I. General information

NPI: 1992127955
Provider Name (Legal Business Name): RANCE LANE RUE B.S.
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/10/2014
Last Update Date: 01/10/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

202 SOUTH WASHITA AVENUE
WYNNEWOOD OK
73098
US

IV. Provider business mailing address

34668 EAST COUNTY ROAD 1650
WYNNEWOOD OK
73098
US

V. Phone/Fax

Practice location:
  • Phone: 405-665-4385
  • Fax: 405-665-6396
Mailing address:
  • Phone: 405-306-1777
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: