Provider Information for 1457663759
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EVALLISON EDDY LPC
Sex: Female
NPI: 1457663759
Last Updated: 2016-03-18
Certification Date:
Certification Date:
Details
| Name | Value | ||||||||
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| NPI | 1457663759 | ||||||||
| Enumeration Date | 2010-07-02 | ||||||||
| NPI Type | NPI-1 Individual | ||||||||
| Sole Proprietor | NO | ||||||||
| Status | Active | ||||||||
| Mailing Address | 231 E GRAHAM AVE PRYOR, OK 74361-2436 United States Phone: 918-825-1405 | Fax:918-825-1406 | ||||||||
| Primary Practice Address | 231 E GRAHAM AVE PRYOR, OK 74361-2436 United States Phone: 918-825-1405 | Fax:918-825-1406 | ||||||||
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