Individual
ELISIA PORTER
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2493 ETHEL LN, GUTHRIE, OK 73044-6455
(405) 246-5131
Mailing address
2493 ETHEL LN, GUTHRIE, OK 73044-6455
(405) 246-5131
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
09/10/2012
Last updated
09/10/2012
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