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General NPI Number Information
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NPI Number | 1932534880
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Entity Type | Organization
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Legal Business Name | CHICKASAW NATION
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Dates
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Enumeration Date | 09/11/2013
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Last Update Date | 09/11/2013
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Provider Practice Location Address
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Address Line | 12998 VILLAGE RD
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City | KINGSTON
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State | OK
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Zip | 73439-5272
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Country | US
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Telephone | 580-564-3060
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Fax |
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Provider Business Mailing Address
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Address Line | 12998 VILLAGE RD
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City | KINGSTON
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State | OK
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Zip | 73439-5272
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Country | US
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Telephone | 580-564-3060
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Fax |
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Authorized Official
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Title or Position | EX OFFICER
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Name | WAYMON HINSON
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Credential |
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Telephone | 580-559-6196
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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 |
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