Individual
CLYDE JEROME COULTER JR.
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
9800 NE 10TH ST, MIDWEST CITY, OK 73130-1507
(405) 706-6945
Mailing address
9800 NE 10TH ST, MIDWEST CITY, OK 73130-1507
(405) 706-6945
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
P080460188
OK
Other
Enumeration date
02/13/2013
Last updated
02/13/2013
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