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NPI Code Detail

MEDICARE: MRS. ANGELA MARIE EUBANKS BS

MEDICARE: MRS. ANGELA MARIE EUBANKS BS
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
1171M00000XCase Manager/Care Coordinator
2101YP2500XProfessional CounselorLPC06251OK

General Provider Information

NPI Number : 1558404087
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. ANGELA MARIE EUBANKS BS
Provider Business Mailing Address
First Line : 1601 OLD SOUTH RIVER RD
Second Line :
City : SAINT CHARLES
State : MO
Zip : 63303-4120
Country : US
Telephone Number : 636-224-1210
Fax Number : 636-246-1008
Provider Business Practice Location Address
First Line : 6440 S LEWIS AVE STE 2200
Second Line :
City : TULSA
State : OK
Zip : 74136-1060
Country : US
Telephone Number : 918-712-0859
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/15/2007
Last Update Date : 04/22/2024

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