Individual
MYLINDA RENEE FANJ
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S., LPC (US)
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
Mailing address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-3554
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
(US) 966
OK
Other
Enumeration date
10/25/2011
Last updated
10/25/2011
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