Individual
JO ANN WALDEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
507 DEWEY AVENUE, POTEAU, OK 74953
(918) 649-0172
Mailing address
507 DEWEY AVENUE, POTEAU, OK 74953
(918) 649-0172
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0000
—
OK
Enumeration date
06/10/2016
Last updated
06/10/2016
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