MEDICARE: MS. NORMA JANE VANTINE M.S., L.P.C.

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	101YP2500X	Professional Counselor	1177	OK

General Provider Information

NPI Number	:	1184860611
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. NORMA JANE VANTINE M.S., L.P.C.

Provider Business Mailing Address
First Line	:	1503 S. DENVER AVE.
Second Line	:	YWCA TULSA
City	:	TULSA
State	:	OK
Zip	:	74119-3828
Country	:	US
Telephone Number	:	918-588-9393
Fax Number	:	918-588-9394

Provider Business Practice Location Address
First Line	:	1503 S. DENVER AVE.
Second Line	:	YWCA TULSA
City	:	TULSA
State	:	OK
Zip	:	74119-3828
Country	:	US
Telephone Number	:	918-588-9393
Fax Number	:	918-588-9394

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

Provider Enumeration Date	:	01/06/2009
Last Update Date	:	01/06/2009

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