Provider Demographics
NPI:1134353808
Name:POPOUR-HOGUE, JANIE M (LADC)
Entity type:Individual
Prefix:
First Name:JANIE
Middle Name:M
Last Name:POPOUR-HOGUE
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24919 S 4420 RD
Mailing Address - Street 2:
Mailing Address - City:VINITA
Mailing Address - State:OK
Mailing Address - Zip Code:74301-5529
Mailing Address - Country:US
Mailing Address - Phone:918-256-9120
Mailing Address - Fax:918-256-6377
Practice Address - Street 1:24919 S 4420 RD
Practice Address - Street 2:
Practice Address - City:VINITA
Practice Address - State:OK
Practice Address - Zip Code:74301-5529
Practice Address - Country:US
Practice Address - Phone:918-256-9120
Practice Address - Fax:918-256-6377
Is Sole Proprietor?:No
Enumeration Date:2009-05-11
Last Update Date:2009-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK326101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)