Individual
ITHA JOYCE GRAY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ICADC
Contact information
Practice address
118 E MAIN ST, HOLDENVILLE, OK 74848-3208
(405) 379-5256
Mailing address
204 LAKESIDE DR, HOLDENVILLE, OK 74848-9537
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
252
OK
Other
Enumeration date
05/23/2007
Last updated
07/08/2007
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