Individual
MS. MARY JO SULLIVAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LADC
Contact information
Practice address
125 PINE TREE LN, NORMAN, OK 73072-5012
(405) 321-8966
Mailing address
125 PINE TREE LN, NORMAN, OK 73072-5012
(405) 321-8966
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
174
OK
Other
Enumeration date
05/03/2007
Last updated
04/22/2020
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