Individual
JUSTUS DAVENPORT
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6501 BROADWAY EXT, SUITE 180, OKLAHOMA CITY, OK 73116-8239
(405) 607-4041
Mailing address
18040 NE 10TH ST, HARRAH, OK 73045-8115
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
03/05/2015
Last updated
03/05/2015
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