Individual
MS. SHANNA RENELL WILLOUGHBY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
300 N DALTON ST, VALLIANT, OK 74764
(580) 286-5777
(580) 286-5132
Mailing address
RR 1 BOX 257, GARVIN, OK 74736-9746
(580) 286-5777
(580) 286-5132
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
20028
OK
Other
Enumeration date
09/17/2007
Last updated
09/17/2007
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