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General NPI Number Information
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NPI Number | 1326350539
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Entity Type | Individual
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Provider Name | HALLA R POWERS CBHCM
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Gender | Female
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Dates
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Enumeration Date | 07/06/2010
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Last Update Date | 11/15/2010
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Provider Practice Location Address
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Address Line | 2 WICKERSHAM ST
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City | MANGUM
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State | OK
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Zip | 73554-9117
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Country | US
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Telephone | 580-782-3337
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Fax | 580-782-3338
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Provider Business Mailing Address
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Address Line | PO BOX 386 2 WICKERSHAM DRIVE
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City | MANGUM
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State | OK
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Zip | 73554-0386
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Country | US
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Telephone | 580-782-3337
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Fax | 580-782-3338
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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 | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 22962
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License Number State | OK
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