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General NPI Number Information
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NPI Number | 1255798914
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Entity Type | Organization
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Legal Business Name | JAN MATHESON COUNSELING
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Dates
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Enumeration Date | 01/25/2016
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Last Update Date | 01/25/2016
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Provider Practice Location Address
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Address Line | 1918 LAKE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-4800
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Country | US
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Telephone | 580-765-2581
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Fax |
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Provider Business Mailing Address
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Address Line | 1918 LAKE RD
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City | PONCA CITY
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State | OK
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Zip | 74604-4800
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Country | US
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Telephone | 580-765-2581
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | JANET MARIE MATHESON
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Credential | LPC
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Telephone | 580-765-2639
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1185
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License Number State | OK
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