MEDICARE: MRS. SAMANTHA J WOHL MS-LPC

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	3745	OK

General Provider Information

NPI Number	:	1205931367
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. SAMANTHA J WOHL MS-LPC

Provider Business Mailing Address
First Line	:	2901 L A CANN DR
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74604-7148
Country	:	US
Telephone Number	:	580-767-1724
Fax Number	:

Provider Business Practice Location Address
First Line	:	222 E GRAND AVE STE 404
Second Line	:
City	:	PONCA CITY
State	:	OK
Zip	:	74601-4319
Country	:	US
Telephone Number	:	580-762-6511
Fax Number	:

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

Provider Enumeration Date	:	09/14/2006
Last Update Date	:	07/08/2007

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