Individual
MITZY KANTOR
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
901 E 11TH ST, CLAREMORE, OK 74017-6443
(918) 813-5304
Mailing address
901 E 11TH ST, CLAREMORE, OK 74017-6443
(918) 813-5304
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
04/30/2014
Last updated
04/30/2014
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