MEDICARE: CARMALETA S MCQUAY MHR

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	:	1104195296
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CARMALETA S MCQUAY MHR

Provider Business Mailing Address
First Line	:	7319 STATE HIGHWAY 3W
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4514
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	126 N OAK AVE
Second Line	:
City	:	ADA
State	:	OK
Zip	:	74820-4851
Country	:	US
Telephone Number	:	580-421-6464
Fax Number	:

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

Provider Enumeration Date	:	12/20/2011
Last Update Date	:	12/20/2011

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