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Organization
SUB ROSA MENTAL SERVICES
Active
Organization
SUB ROSA MENTAL SERVICES
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. SHILOH MARTIN LPC (MENTAL HEALTH PROVIDER)
(808) 452-2515
Entity
Organization
Contact information
Practice address
14674 U.S. 169, OOLOGAH, OK 74053
(808) 452-2515
Mailing address
14019 S WILLOW DR, OOLOGAH, OK 74053-3982
(808) 452-2515
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/02/2023
Last updated
08/02/2023
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