Individual
MIJA SELF
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
813 N WILLOW, LEHIGH, OK 74523
(580) 378-2920
Mailing address
PO BOX 253, LEHIGH, OK 74556-0253
(580) 298-2830
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
7171
OK
103K00000X
Behavior Analyst
—
—
171M00000X
Case Manager/Care Coordinator
—
—
390200000X
Student in an Organized Health Care Education/Training Program
—
—
Other
Enumeration date
11/23/2011
Last updated
08/30/2023
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