Individual
MRS. CAROLYN RISOR-WAGNER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MCP, LPC
Contact information
Practice address
1625 W OWEN K GARRIOTT RD STE F, ENID, OK 73703-5653
(580) 242-4673
Mailing address
1625 W OWEN K GARRIOTT RD STE F, ENID, OK 73703-5653
(580) 242-4673
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20-5274892
—
OK
Enumeration date
02/01/2010
Last updated
06/13/2013
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