Individual
HENRIETTA MAE NELSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
400 N EASTERN AVE, MOORE, OK 73160-5833
(405) 659-5858
Mailing address
PO BOX 7376, MOORE, OK 73153-1376
(505) 918-3167
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
104100000X
Social Worker
—
—
Other
Enumeration date
10/18/2017
Last updated
10/23/2017
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