Individual
EBONY TYLER PORTIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHS
Contact information
Practice address
1900 NE 36TH ST STE 100G, OKLAHOMA CITY, OK 73111-5218
(405) 270-0005
Mailing address
1900 NE 36TH ST STE 100G, OKLAHOMA CITY, OK 73111-5218
(405) 270-0005
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
101YP2500X
—
Other
Enumeration date
04/03/2012
Last updated
04/03/2012
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