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Individual

MYSTIC D CRENSHAW

Active
Sole proprietor
No

Provider details

NPI number
Gender
F

Contact information

Practice address
3100 S ELM PL STE B, BROKEN ARROW, OK 74012-7950
(918) 286-2535
(918) 286-7693
Mailing address
1008 N CHEROKEE AVE, CLAREMORE, OK 74017-5839
(918) 798-5326

Taxonomy

Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary

Other

Enumeration date
03/10/2011
Last updated
03/10/2011
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