Individual
DEBORAH LOUELLA MARGERUM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCP,LPC CANDIDATE
Contact information
Practice address
BRIDGEWAY, INC., 620 W GRAND, PONCA CITY, OK 74601-5123
(580) 762-1462
(580) 765-7299
Mailing address
BRIDGEWAY, INC, 620 W GRAND, PONCA CITY, OK 74601
(580) 762-1462
(580) 765-7299
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1222
OK
101YM0800X
Mental Health Counselor
6332
OK
Other
Enumeration date
04/15/2010
Last updated
02/03/2020
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