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Mental Health >> Counselor >> Behavioral Health & Social Service Providers

Registrant NPI Number: 1083052146

Individual Registrant:
Gender: M
Sole Proprietor

Location and contact information for practice:
717B HIGHWAY 70 E  KINGSTON, OK 73439-8253 US
Tel: 580-565-2415  Fax: --

Contact information for business:
717B HIGHWAY 70 E  KINGSTON, OK 73439-8253 US
Tel: 580-565-2415  Fax: --

Registration Information:
NPI: 1083052146
Entity Type: Individual

Specialty information:

PrimaryCodeCategory/DescriptionStateLicense Number
Y101YM0800XBehavioral Health & Social Service Providers
Mental Health

Legacy codes, insurance codes and state license numbers:



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