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General NPI Number Information
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NPI Number | 1821355678
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Entity Type | Organization
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Legal Business Name | HOPE FAMILY CLINIC
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Dates
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Enumeration Date | 04/18/2012
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Last Update Date | 04/18/2012
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Provider Practice Location Address
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Address Line | 1817 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-3614
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Country | US
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Telephone | 580-583-5737
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Fax |
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Provider Business Mailing Address
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Address Line | 1817 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73501-3614
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Country | US
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Telephone | 580-583-5737
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MRS. RITA U DANIEL
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Credential | LPC, NCC, LADC
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Telephone | 580-583-5757
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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 | 3153
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License Number State | OK
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