Individual
MISS CASEY MAE TRIMBLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1115 HARBOR RD, GROVE, OK 74344-3505
(918) 857-1812
Mailing address
67009 E 261 RD, GROVE, OK 74344-6118
(918) 857-1812
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
101Y00000X
—
OK
Enumeration date
08/11/2010
Last updated
06/25/2021
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