Individual
TRACY DIAN FOUNTAIN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
BHRS
Contact information
Practice address
27753 S WELLING RD, WELLING, OK 74471-2202
(918) 457-4999
(918) 457-4104
Mailing address
27753 S WELLING RD, WELLING, OK 74471-2202
(918) 457-4999
(918) 457-4104
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
01/06/2012
Last updated
01/06/2012
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