Provider Demographics
NPI:1093045429
Name:HEWETT, JOHN (LPC)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:
Last Name:HEWETT
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:405 MAGNOLIA ST
Mailing Address - Street 2:
Mailing Address - City:TAHLEQUAH
Mailing Address - State:OK
Mailing Address - Zip Code:74464-4818
Mailing Address - Country:US
Mailing Address - Phone:918-207-9518
Mailing Address - Fax:
Practice Address - Street 1:405 MAGNOLIA ST
Practice Address - Street 2:
Practice Address - City:TAHLEQUAH
Practice Address - State:OK
Practice Address - Zip Code:74464-4818
Practice Address - Country:US
Practice Address - Phone:918-207-9518
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-01-07
Last Update Date:2011-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health