Individual
MS. SANDRA SUE DALE BOULWARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC, MAC
Contact information
Practice address
1121 K ST NW, MIAMI, OK 74354-2915
(918) 542-5671
Mailing address
1121 K ST NW, MIAMI, OK 74354-2915
(918) 542-5671
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
440
OK
101YP2500X
Professional Counselor
15991
OK
101YP2500X
Professional Counselor
Primary
440
OK
101YS0200X
School Counselor
109413
OK
Other
Enumeration date
05/01/2009
Last updated
05/01/2009
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