Provider Demographics
NPI:1427175363
Name:DISCOVERY UTTUWAH LLC
Entity type:Organization
Organization Name:DISCOVERY UTTUWAH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUE
Authorized Official - Middle Name:
Authorized Official - Last Name:BILLUPS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:918-485-1573
Mailing Address - Street 1:118 S MAIN ST
Mailing Address - Street 2:
Mailing Address - City:WAGONER
Mailing Address - State:OK
Mailing Address - Zip Code:74467-5221
Mailing Address - Country:US
Mailing Address - Phone:918-485-1573
Mailing Address - Fax:918-485-1575
Practice Address - Street 1:118 S MAIN ST
Practice Address - Street 2:
Practice Address - City:WAGONER
Practice Address - State:OK
Practice Address - Zip Code:74467-5221
Practice Address - Country:US
Practice Address - Phone:918-485-1573
Practice Address - Fax:918-485-1575
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK2620101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty