Individual
BEATRICE WALLER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2500 SHORELINE DR, NORMAN, OK 73026-1319
(580) 436-7098
Mailing address
2500 SHORELINE DR, NORMAN, OK 73026-1319
(580) 436-7098
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3191
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
0310378555-8
HEALTHCARE PROVIDERS SERVICE ORGANIZATION
PA
Enumeration date
10/17/2017
Last updated
06/16/2018
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