Individual
THERESA R PAGE-BOHANNAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
414 E 3RD ST STE D, GROVE, OK 74344-7130
(918) 786-4331
(918) 786-4332
Mailing address
414 E 3RD ST STE D, GROVE, OK 74344-7130
(918) 786-4331
(918) 786-4332
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1975
OK
Other
Enumeration date
04/27/2007
Last updated
07/29/2008
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