Individual
BEN IMAGIEDOUGLAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
6803 S WESTERN AVE, SUITE 404, OKLAHOMA CITY, OK 73139-1808
(405) 420-4840
(405) 286-3060
Mailing address
PO BOX 75194, OKLAHOMA CITY, OK 73147-0194
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
101Y00000X
OK
101Y00000X
Counselor
—
—
Other
Enumeration date
01/08/2015
Last updated
01/08/2015
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