Individual
DALEY TEARL
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LMFT, LADC
Contact information
Practice address
100 W 7TH ST, SUITE 102, OKMULGEE, OK 74447-5007
(918) 758-1910
(918) 756-1270
Mailing address
3308 S. 359TH W PL, P.O. BOX 1723, MANNFORD, OK 74044
(918) 865-8212
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
265
OK
106H00000X
Marriage & Family Therapist
821
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
300522336
MEDICARE
OK
Enumeration date
07/20/2006
Last updated
03/13/2009
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