Basic Information
| Provider Information | |||||||||
| NPI: | 1306128624 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | POGUE | ||||||||
| FirstName: | PAMELA | ||||||||
| MiddleName: | GAYLE | ||||||||
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| Mailing Information | |||||||||
| Address1: | 617 2ND ST APT H1 | ||||||||
| Address2: | |||||||||
| City: | ELGIN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 735389229 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 9187981821 | ||||||||
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| Practice Location | |||||||||
| Address1: | 330 W GRAY ST STE 140 | ||||||||
| Address2: | |||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730697118 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4059196821 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 09/13/2011 | ||||||||
| LastUpdateDate: | 09/13/2011 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 104100000X | Y | Behavioral Health & Social Service Providers | Social Worker |
No ID Information.