Individual
SAMANTHA RONAE BUMGUARDNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
YOUTH SERVICE
Contact information
Practice address
205 J T STITES BLVD, SALLISAW, OK 74955-9323
(918) 775-7787
(918) 775-0328
Mailing address
205 S J T STITES ST, SALLISAW, OK 74955-9301
(918) 775-7787
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
10/21/2024
Last updated
10/21/2024
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