Individual
DEBRA BEVILL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
504 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-9933
Mailing address
504 E 24TH ST, TISHOMINGO, OK 73460-3214
(580) 371-9933
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1457613002
—
OK
Enumeration date
05/23/2014
Last updated
05/23/2014
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