Individual
MITUL SHAH
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
525 N VINE ST, JENKS, OK 74037-3471
(918) 269-0932
Mailing address
525 N VINE ST, JENKS, OK 74037-3471
(918) 269-0932
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
175T00000X
Peer Specialist
Primary
—
—
Other
Enumeration date
01/03/2025
Last updated
01/03/2025
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