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Individual

MR. TOM B WAGES III

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
LCSW, ACSW

Contact information

Practice address
10703 E 111TH ST S, BIXBY, OK 74008-2843
(918) 695-3336
Mailing address
10703 E 111TH ST S, BIXBY, OK 74008-2843
(918) 695-3336

Taxonomy

Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
2174
OK

Other

Enumeration date
07/28/2010
Last updated
07/28/2010
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