Individual
MR. EUGENE MBADIWE EZEALA
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1713 VICTORIA DR, EDMOND, OK 73003-3860
(310) 619-8514
Mailing address
1713 VICTORIA DR, EDMOND, OK 73003-3860
(310) 619-8514
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
05/27/2010
Last updated
05/27/2010
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