MEDICARE: MISS PAIGE LAUREN CUDJOE B.H.R.S.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101Y00000X	Counselor

General Provider Information

NPI Number	:	1083962997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MISS PAIGE LAUREN CUDJOE B.H.R.S.

Provider Business Mailing Address
First Line	:	1816 NAPA VALLEY RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2982
Country	:	US
Telephone Number	:	405-850-2390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1816 NAPA VALLEY RD
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-2982
Country	:	US
Telephone Number	:	405-850-2390
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	08/27/2012
Last Update Date	:	08/27/2012

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