Individual
JORDAN MARQUETT PRESLEY I
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
109 S HARRILL AVE, WAGONER, OK 74467-5317
(918) 485-0242
Mailing address
3036 S 214TH ST W, BOYNTON, OK 74422-5103
(539) 286-9624
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
OK
101Y00000X
Counselor
—
—
Other
Enumeration date
06/12/2020
Last updated
06/12/2020
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