Individual
REBECCA MCCOLLUM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
507 DEWEY AVE, POTEAU, OK 74953-4215
(918) 649-0172
Mailing address
507 DEWEY AVE, POTEAU, OK 74953-4215
(918) 649-0172
(918) 649-0315
Taxonomy
Speciality
Code
Description
License number
State
261QM0855X
Adolescent and Children Mental Health Clinic/Center
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000
—
OK
Enumeration date
02/13/2017
Last updated
02/13/2017
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