Provider Demographics
NPI:1669644605
Name:WAHNEE, JOY ALICE (MS LADC)
Entity Type:Individual
Prefix:MS
First Name:JOY
Middle Name:ALICE
Last Name:WAHNEE
Suffix:
Gender:F
Credentials:MS LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1020 LENAPE DRIVE
Mailing Address - Street 2:
Mailing Address - City:NOWATA
Mailing Address - State:OK
Mailing Address - Zip Code:74048
Mailing Address - Country:US
Mailing Address - Phone:918-273-7555
Mailing Address - Fax:918-273-3451
Practice Address - Street 1:1020 LENAPE DRIVE
Practice Address - Street 2:
Practice Address - City:NOWATA
Practice Address - State:OK
Practice Address - Zip Code:74048
Practice Address - Country:US
Practice Address - Phone:918-273-7555
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-31
Last Update Date:2008-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK429101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK429OtherOKLA BOARD OF LICENSED AL