Individual
MISS EBONY MICHELLE SMITH
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
912 BLACK JACK LN, MOORE, OK 73160-0900
(405) 406-6010
Mailing address
912 BLACK JACK LN, MOORE, OK 73160-0900
(405) 406-6010
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
—
—
Other
Enumeration date
01/14/2010
Last updated
01/14/2010
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