Individual
MRS. TISH YORK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1102 N PHILADELPHIA AVE, SHAWNEE, OK 74801-5120
(405) 788-8554
Mailing address
1102 N PHILADELPHIA AVE, SHAWNEE, OK 74801-5120
(405) 788-8554
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
171M00000X
Case Manager/Care Coordinator
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200460940B
—
OK
Enumeration date
08/01/2012
Last updated
02/26/2016
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