Individual
VIRGINIA TEDLOCK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC
Contact information
Practice address
1904 GORDON COOPER DR, SHAWNEE, OK 74801-8603
(405) 273-2157
Mailing address
394006 E LL50 RD, WELEETKA, OK 74880
(918) 652-1643
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1965
OK
Other
Enumeration date
03/02/2017
Last updated
03/02/2017
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