Individual
MEGHAN THEOBALD
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
428 S MUSTANG RD, YUKON, OK 73099-6754
(405) 217-8400
Mailing address
310 12TH AVE NE, NORMAN, OK 73071-5238
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3638
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200253070B
—
OK
Enumeration date
06/30/2011
Last updated
06/30/2011
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