Jo Ann Dupree Matlock, LPC

Individual provider Active NPI Professional Counselor · Valliant, OK

NPI 1881920783 · NPPES record last updated Oct 27, 2009

Key facts

NPI
1881920783
Entity type
Individual (NPI type 1)
Primary specialty
Professional Counselor 101YP2500X
License
2779 (OK)
Practice address
RR 1 Box 627
Valliant, OK 74764-9655
Phone
(580) 933-7229
NPI assigned
Oct 27, 2009
Sex
Female
Sole proprietor
Yes

Medicare participation

Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

Medicare enrollment (NPD)
No

State licenses

LicenseStateTypeSpecialty
2779OKMDClinical Social Worker

Specialties & licenses

Specialty (taxonomy)CodeLicenseStatePrimary
Professional Counselor 101YP2500X 2779 OK Yes

Addresses

Primary practice location

RR 1 Box 627
Valliant, OK 74764-9655

Mailing address

RR 1 Box 627
Valliant, OK 74764-9655
Phone (580) 933-7229

Other identifiers

IdentifierTypeStateIssuer
2779MedicaidOK

Other providers in Valliant, OK

All providers in Valliant, OK · Professional Counselor in Oklahoma

Sources for this page

Verify at the official NPI Registry.