Individual
THEOPHILUS D AMENGAETEOHO
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BHRS
Contact information
Practice address
5714 S WESTERN AVE, OKLAHOMA CITY, OK 73109-4515
(405) 601-1154
(405) 601-1183
Mailing address
5714 S WESTERN AVE, OKLAHOMA CITY, OK 73109-4515
(405) 601-1154
(405) 601-1183
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/04/2012
Last updated
09/04/2012
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