MEDICARE: MRS. BARBARA ANN NEIL CADC

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	172	OK

General Provider Information

NPI Number	:	1770802936
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MRS. BARBARA ANN NEIL CADC

Provider Business Mailing Address
First Line	:	16425 GRACE ANN CT
Second Line	:
City	:	EDMOND
State	:	OK
Zip	:	73013-3285
Country	:	US
Telephone Number	:	405-285-1656
Fax Number	:	405-752-5787

Provider Business Practice Location Address
First Line	:	10802 QUAIL PLAZA DR
Second Line	:	SUITE 124
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-3116
Country	:	US
Telephone Number	:	405-474-6884
Fax Number	:	405-752-5787

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

Provider Enumeration Date	:	05/26/2010
Last Update Date	:	06/16/2010

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