Individual
MANDY COLLEEN DILLARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
213 W BROADWAY AVE, ELK CITY, OK 73644-4741
(866) 926-6552
Mailing address
213 W BROADWAY AVE, ELK CITY, OK 73644-4741
(866) 926-6552
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
305R00000X
OK
Other
Enumeration date
09/12/2019
Last updated
09/12/2019
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