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General NPI Number Information
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NPI Number | 1750610614
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Entity Type | Individual
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Provider Name | TAWANDA MAE NORTHCUTT LPC CANDIDATE
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Gender | Female
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Dates
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Enumeration Date | 12/23/2009
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Last Update Date | 12/23/2009
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Provider Practice Location Address
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Address Line | 202 S WASHITA AVE
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City | WYNNEWOOD
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State | OK
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Zip | 73098-7820
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Country | US
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Telephone | 405-665-4385
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Fax |
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Provider Business Mailing Address
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Address Line | 12619 COUNTY ROAD 3520
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City | ADA
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State | OK
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Zip | 74820-1711
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Country | US
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Telephone | 580-559-9595
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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