Individual
LONNIE CARBAUGH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
LPC
Contact information
Practice address
111 E 12TH ST, ADA, OK 74820-6501
(580) 436-2690
Mailing address
111 E 12TH ST, ADA, OK 74820-6501
(580) 436-2690
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
3257
OK
Other
Enumeration date
11/29/2016
Last updated
11/29/2016
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