Provider Information for 1609411214
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CHANDRA LONE WOLF LMSW-P
Sex: Female
NPI: 1609411214
Last Updated: 2019-11-07
Certification Date:
Certification Date:
Details
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NPI | 1609411214 | ||||||||
Enumeration Date | 2019-11-07 | ||||||||
NPI Type | NPI-1 Individual | ||||||||
Sole Proprietor | NO | ||||||||
Status | Active | ||||||||
Mailing Address | PO BOX 1059 MCLOUD, OK 74851-1059 United States Phone: 405-964-2618 | Fax: | ||||||||
Primary Practice Address | 105365 S HIGHWAY 102 MCLOUD, OK 74851-3051 United States Phone: 405-964-2618 | Fax: | ||||||||
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