Individual
MISS GAY FONTAINA WILLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
BHRS CM
Contact information
Practice address
1015 WATERWOOD PKWY, G-N2, EDMOND, OK 73034-5327
(405) 863-2224
(405) 285-1652
Mailing address
225 CAMBRIDGE DR, MIDWEST CITY, OK 73110-3464
(405) 610-6675
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
05/04/2010
Last updated
03/21/2012
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