Individual
MRS. CICELY CHARLSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1021 W 117TH ST S, JENKS, OK 74037-5025
(918) 360-9841
Mailing address
1021 W 117TH ST S, JENKS, OK 74037-5025
(918) 360-9841
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
04/21/2010
Last updated
04/21/2010
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