Provider Demographics
NPI:1356685192
Name:SQUIRE, ALISON JOY (MS)
Entity Type:Individual
Prefix:
First Name:ALISON
Middle Name:JOY
Last Name:SQUIRE
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1733 W 33RD ST
Mailing Address - Street 2:SUITE 110
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3865
Mailing Address - Country:US
Mailing Address - Phone:405-250-7448
Mailing Address - Fax:
Practice Address - Street 1:1733 W 33RD ST
Practice Address - Street 2:SUITE 110
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3865
Practice Address - Country:US
Practice Address - Phone:405-250-7448
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-11-17
Last Update Date:2012-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health