Individual
MISS MIREILLE INDEM FONSA
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
M.S
Contact information
Practice address
9210 S WESTERN AVE STE A-21, OKLAHOMA CITY, OK 73139-4982
(405) 676-9227
Mailing address
9210 S WESTERN AVE STE A-21, OKLAHOMA CITY, OK 73139-4982
(405) 676-9227
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Enumeration date
08/13/2018
Last updated
04/08/2021
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