Organization
PURE DIVERGENCE
Active
Other names
Sarah Whitewater
Organization subpart
No
Provider details
NPI number
Authorized official
SARAH WHITEWATER (OWNER)
(405) 779-4334
Entity
Organization
Contact information
Practice address
508 CHEROKEE GATE DR, MUSTANG, OK 73064-0334
(405) 779-4334
Mailing address
PO BOX 334, MUSTANG, OK 73064-0334
(405) 779-4334
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Enumeration date
10/16/2012
Last updated
10/26/2012
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