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Individual

MR. JOHNNY MARVELL LEAKE SR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
M.ED

Contact information

Practice address
613 BATH CIR, OKLAHOMA CITY, OK 73117-3024
(405) 208-4045
Mailing address
613 BATH CIR, OKLAHOMA CITY, OK 73117-3024
(405) 208-4045

Taxonomy

Speciality
Code
Description
License number
State
225C00000X
Rehabilitation Counselor
Primary

Other

Enumeration date
07/10/2010
Last updated
07/10/2010
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