Provider Demographics
NPI:1225288863
Name:DURRENCE, GEORGE WAYNE (MBS, LBP)
Entity Type:Individual
Prefix:MR
First Name:GEORGE
Middle Name:WAYNE
Last Name:DURRENCE
Suffix:
Gender:M
Credentials:MBS, LBP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:304 SW C ST
Mailing Address - Street 2:
Mailing Address - City:ANTLERS
Mailing Address - State:OK
Mailing Address - Zip Code:74523-3849
Mailing Address - Country:US
Mailing Address - Phone:580-298-3846
Mailing Address - Fax:580-298-3847
Practice Address - Street 1:304 SW C ST
Practice Address - Street 2:
Practice Address - City:ANTLERS
Practice Address - State:OK
Practice Address - Zip Code:74523-3849
Practice Address - Country:US
Practice Address - Phone:580-298-3846
Practice Address - Fax:580-298-3847
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-19
Last Update Date:2012-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK0338101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health