Individual
TRACE DARR
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
1336 N HARRISON AVE, SHAWNEE, OK 74801-5206
(405) 424-7711
Mailing address
35977 HIGHWAY 9 E, SEMINOLE, OK 74868-6631
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/06/2022
Last updated
03/03/2023
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