Individual
DR. MAVONNA MARIE ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
PHD
Contact information
Practice address
1616 S AUGUST ST, STILLWATER, OK 74074-1837
(405) 564-0656
Mailing address
1616 S AUGUST ST, STILLWATER, OK 74074-1837
(405) 564-0656
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
3974
OK
Other
Enumeration date
06/20/2006
Last updated
10/15/2008
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