Individual
TERRI THELEN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
MA
Contact information
Practice address
905 NW 4TH ST, STIGLER, OK 74462-1652
(918) 967-8223
Mailing address
601 W LIBERTY RD., ATOKA, OK 74525-4418
(303) 345-7045
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
5488
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200534390A
—
OK
Enumeration date
07/31/2013
Last updated
03/30/2015
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