Individual
CRYSTAL NEEDHAM
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
104 W EP 2030 ST, QUINTON, OK 74561-1066
(918) 429-2649
Mailing address
104 W EP 2030 ST, QUINTON, OK 74561-1066
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/23/2012
Last updated
01/23/2012
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