Individual
TIMOTHY WAYNE FOREMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
16414 W 760 RD, TAHLEQUAH, OK 74464-1675
(918) 708-9009
Mailing address
PO BOX 73, OAKS, OK 74359-0073
(918) 907-4142
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
251K00000X
Public Health or Welfare Agency
—
—
Other
Enumeration date
04/14/2023
Last updated
04/14/2023
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