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Individual

ELISSA E MOBLEY

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
F

Contact information

Practice address
1410 S GIN RD, ATOKA, OK 74525
(580) 889-3399
Mailing address
2111 MEADOWLARK LN, IDABEL, OK 74745-3726
(318) 393-9172

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
200287120A
OK
Enumeration date
04/17/2013
Last updated
04/18/2013
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