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General NPI Number Information
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NPI Number | 1285037762
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Entity Type | Individual
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Provider Name | JOHN SOAP JR.
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Gender | Male
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Dates
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Enumeration Date | 09/29/2014
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Last Update Date | 02/14/2024
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Provider Practice Location Address
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Address Line | 1336 N HARRISON AVE
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City | SHAWNEE
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State | OK
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Zip | 74801-5206
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Country | US
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Telephone | 140-542-4771
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Fax |
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Provider Business Mailing Address
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Address Line | 2029 GORDON COOPER DR
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City | SHAWNEE
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State | OK
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Zip | 74801-9005
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Country | US
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Telephone | 405-878-4716
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Fax | 405-878-4708
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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 | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State | OK
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