Provider Demographics
NPI:1558804815
Name:WITHROW, VANESSA ANN
Entity Type:Individual
Prefix:
First Name:VANESSA
Middle Name:ANN
Last Name:WITHROW
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:18173 US HIGHWAY 70
Mailing Address - Street 2:
Mailing Address - City:LONE GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:73443-6541
Mailing Address - Country:US
Mailing Address - Phone:580-319-6040
Mailing Address - Fax:
Practice Address - Street 1:18173 US HIGHWAY 70
Practice Address - Street 2:
Practice Address - City:LONE GROVE
Practice Address - State:OK
Practice Address - Zip Code:73443-6541
Practice Address - Country:US
Practice Address - Phone:580-319-6040
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-18
Last Update Date:2016-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health