Individual
MAGAN MARIE WILLINGHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
2100 SE WASHINGTON ST, IDABEL, OK 74745-5449
(580) 298-5062
(580) 298-9958
Mailing address
307 MCGEE CHAPEL RD, BROKEN BOW, OK 74728-5950
(580) 212-7064
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
08/02/2011
Last updated
02/20/2019
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