Individual
MRS. RENAE TRACIE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MASTERS
Contact information
Practice address
1309 S. 37TH ST., MUSKOGEE, OK 74401-7908
(918) 913-2434
Mailing address
1309 S 37TH ST, MUSKOGEE, OK 74401-7908
(918) 913-2434
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
730947232
OK
Other
Enumeration date
11/27/2007
Last updated
07/27/2012
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