Individual
IRVING BACCUS JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
6000 E RENO AVE APT 1106, MIDWEST CITY, OK 73110-2013
(405) 659-5137
Mailing address
6000 E RENO AVE APT 1106, MIDWEST CITY, OK 73110-2013
(405) 659-5137
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Enumeration date
07/06/2012
Last updated
07/06/2012
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