Individual
MR. JOHN THOMAS COULBOURN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A., LPC (UNDER SU)
Contact information
Practice address
1405 BLAIR ST, POCOLA, OK 74902-2860
(407) 641-4695
Mailing address
1405 BLAIR ST, POCOLA, OK 74902-2860
(407) 641-4695
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1841458262
—
FL
Enumeration date
06/02/2008
Last updated
02/29/2012
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