Provider Demographics
NPI:1316350341
Name:DANIEL, SALLY (BHRS)
Entity type:Individual
Prefix:
First Name:SALLY
Middle Name:
Last Name:DANIEL
Suffix:
Gender:F
Credentials:BHRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:355004 E 750 RD
Mailing Address - Street 2:
Mailing Address - City:CUSHING
Mailing Address - State:OK
Mailing Address - Zip Code:74023-5269
Mailing Address - Country:US
Mailing Address - Phone:918-225-0750
Mailing Address - Fax:918-225-3137
Practice Address - Street 1:355004 E 750 RD
Practice Address - Street 2:
Practice Address - City:CUSHING
Practice Address - State:OK
Practice Address - Zip Code:74023-5269
Practice Address - Country:US
Practice Address - Phone:918-225-0750
Practice Address - Fax:918-225-3137
Is Sole Proprietor?:Yes
Enumeration Date:2014-06-06
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health