Individual
AUDRA D TOLBERT-MARTIN
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
LPC-SUPERVISION
Contact information
Practice address
715 N 1ST AVE, DURANT, OK 74701-3801
(580) 931-3008
(580) 931-8022
Mailing address
1381 PEARCE DR, POTTSBORO, TX 75076-7067
(646) 246-3010
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200049040
—
OK
Enumeration date
11/14/2011
Last updated
11/14/2011
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