Individual
MS. DEBRA MARIE HEDDLESTEN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.ED, LADC, CM-D
Contact information
Practice address
120 W 1ST ST, WATONGA, OK 73772-3643
(580) 623-2548
(580) 623-2668
Mailing address
PO BOX 92, ALBERT, OK 73001-0092
(580) 330-2247
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
566
OK
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
3DMH58
ICIS ID
OK
Enumeration date
08/10/2006
Last updated
06/25/2010
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