Individual
MRS. TISHA J FITZGERALD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
508 VETERANS, TALIHINA, OK 74571
(918) 567-3293
Mailing address
11287 SE 222ND RD, TALIHINA, OK 74571-5896
(918) 373-3139
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
06/17/2013
Last updated
06/17/2013
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