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NPI Code Detail

MEDICARE: ANNA MARIE IRWIN M.A.

MEDICARE: ANNA MARIE IRWIN M.A.
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
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1396885133
Entity Type Code : Individual
Provider Name (Legal Business Name) : ANNA MARIE IRWIN M.A.
Provider Business Mailing Address
First Line : 2204 SUNSET RIDGE DR
Second Line :
City : MUSKOGEE
State : OK
Zip : 74403-8489
Country : US
Telephone Number : 918-351-3900
Fax Number :
Provider Business Practice Location Address
First Line : 619 N MAIN ST
Second Line :
City : MUSKOGEE
State : OK
Zip : 74401-4431
Country : US
Telephone Number : 918-682-8407
Fax Number : 918-687-0976
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/08/2007
Last Update Date : 07/08/2007

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