Individual
SAMANTHA NELSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
103 1/2 W MAIN ST, WILBURTON, OK 74578-4043
(918) 465-7890
Mailing address
103 1/2 W MAIN ST, WILBURTON, OK 74578-4043
(918) 465-7890
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
—
Other
Enumeration date
08/07/2015
Last updated
08/07/2015
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