Provider Demographics
NPI:1114167558
Name:WELLSTON PUBLIC SCHOOLS
Entity Type:Organization
Organization Name:WELLSTON PUBLIC SCHOOLS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:JILL
Authorized Official - Middle Name:M
Authorized Official - Last Name:BASHORUN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-356-2533
Mailing Address - Street 1:800 BIRCH STREET
Mailing Address - Street 2:PO BOX 60
Mailing Address - City:WELLSTON
Mailing Address - State:OK
Mailing Address - Zip Code:74881
Mailing Address - Country:US
Mailing Address - Phone:405-356-2533
Mailing Address - Fax:405-356-2838
Practice Address - Street 1:800 BIRCH STREET
Practice Address - Street 2:
Practice Address - City:WELLSTON
Practice Address - State:OK
Practice Address - Zip Code:74881
Practice Address - Country:US
Practice Address - Phone:405-356-2533
Practice Address - Fax:405-356-2838
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-02-25
Last Update Date:2009-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health