Individual
MS. MARY TEISITA RUSSELL
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
70 N 31ST ST, CLINTON, OK 73601-9116
(580) 323-2061
(580) 323-5635
Mailing address
618 N STATE ST, WEATHERFORD, OK 73096-3840
(580) 335-1079
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
04/05/2011
Last updated
04/05/2011
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