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General NPI Number Information
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NPI Number | 1265610471
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Entity Type | Individual
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Provider Name | LYUBOV LYNN SPEEGLE PAC
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Gender | Female
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Dates
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Enumeration Date | 02/11/2008
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Last Update Date | 12/12/2024
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Provider Practice Location Address
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Address Line | 4107 N COUNCIL RD
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City | BETHANY
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State | OK
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Zip | 73008-3131
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Country | US
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Telephone | 405-889-6366
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Fax |
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Provider Business Mailing Address
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Address Line | 10100 MILLSPAUGH WAY
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City | YUKON
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State | OK
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Zip | 73099-7975
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Country | US
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Telephone | 405-615-1178
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363AM0700X
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Taxonomy Name | Medical Physician Assistant
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License Number | 1685
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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