Individual
MR. RUSSELL WAYNE BINGHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
CADC
Contact information
Practice address
4009 EUFALA ST, MUSKOGEE, OK 74403
(918) 681-0484
Mailing address
1203 E BROADWAY, MUSKOGEE, OK 74403
(918) 682-2841
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
52
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
52
CADC
OK
Enumeration date
03/06/2007
Last updated
07/08/2007
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