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Individual

MS. LEONA LILLIAN TANNER

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADC

Contact information

Practice address
109 N MAIN ST, BRISTOW, OK 74010-2429
(918) 367-1114
(918) 367-1115
Mailing address
109 N MAIN ST, BRISTOW, OK 74010-2429
(918) 367-1114
(918) 367-1115

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
1095
OK
225C00000X
Rehabilitation Counselor

Other

Enumeration date
09/15/2009
Last updated
12/30/2013
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