Individual
MRS. ALLIE GRANTHAM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MHR, LPC, CADC
Contact information
Practice address
529 N OAK AVE, TAHLEQUAH, OK 74464
(918) 444-2126
(918) 458-2300
Mailing address
31824 E 720 RD, WAGONER, OK 74467-7374
(918) 485-9661
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
6374
OK
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
Other
Enumeration date
03/02/2007
Last updated
10/16/2019
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