Individual
KEONDRA LATRECE DOYLE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6202 S LEWIS AVE, STE H, TULSA, OK 74136-1099
(918) 899-7284
Mailing address
2215 N MAIN ST, TULSA, OK 74106-3636
(918) 697-5757
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
20028712OA
—
OK
Enumeration date
11/10/2012
Last updated
11/10/2012
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