Individual
MR. KITTAKONE SIRISOMBATH SR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1805 NE 53RD ST, OKLAHOMA CITY, OK 73111-7011
(405) 476-8412
Mailing address
1805 NE 53RD ST, OKLAHOMA CITY, OK 73111-7011
(405) 476-8412
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/05/2015
Last updated
10/05/2015
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