Individual
MICAH DELENE FORAKER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
278871 E 1840 RD, COMANCHE, OK 73529-4042
(580) 467-3173
Mailing address
278871 E 1840 RD, COMANCHE, OK 73529-4042
(580) 467-3173
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
08/03/2018
Last updated
08/03/2018
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