Individual
MR. CORI VALDENE PHILLIPS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1704 E 73RD ST APT 702, TULSA, OK 74136-7410
(404) 895-6122
Mailing address
1704 E 73RD ST APT 702, TULSA, OK 74136-7410
(404) 895-6122
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
UNDER SUPERVISION
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200385110
—
OK
Enumeration date
01/23/2011
Last updated
11/19/2012
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