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General NPI Number Information
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NPI Number | 1558722652
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Entity Type | Individual
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Provider Name | JESSE CRAIGHEAD
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Gender | Male
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Dates
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Enumeration Date | 03/16/2016
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Last Update Date | 03/16/2016
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Provider Practice Location Address
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Address Line | 747 HIGHWAY 59 # 4
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City | WESTVILLE
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State | OK
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Zip | 74965-1508
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Country | US
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Telephone | 918-723-3757
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Fax |
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Provider Business Mailing Address
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Address Line | 747 HIGHWAY 59 # 4
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City | WESTVILLE
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State | OK
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Zip | 74965-1508
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Country | US
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Telephone |
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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 | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 200534020A
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License Number State | OK
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