Individual
ANDREA NUNNALLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MS
Contact information
Practice address
807 SW F AVE, LAWTON, OK 73501-4506
(580) 595-7000
Mailing address
4528 NW CHEYENNE AVE, LAWTON, OK 73505-3245
(580) 695-8411
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
731-54-5165
—
OK
Enumeration date
03/29/2010
Last updated
04/23/2010
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