Individual
JOHN DAVID LAND
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
4515 EDGEWOOD, SAPULPA, OK 74066-8908
(918) 734-9890
Mailing address
4515 EDGEWOOD, SAPULPA, OK 74066
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
10/24/2014
Last updated
10/24/2014
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