Individual
MR. MODEBOLA FADARE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9210 S WESTERN AVE, STE A-21, OKLAHOMA CITY, OK 73139-4982
(405) 246-9259
(405) 606-7893
Mailing address
9210 S WESTERN AVE, STE A-21, OKLAHOMA CITY, OK 73139-4982
(405) 246-9259
(405) 606-7893
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
101YP2500X
Professional Counselor
6107
OK
225400000X
Rehabilitation Practitioner
—
—
Other
Enumeration date
03/27/2013
Last updated
05/16/2016
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