Individual
MARK THROCKMORTON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
701 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
(918) 207-0558
Mailing address
701 S MUSKOGEE AVE, TAHLEQUAH, OK 74464-4717
(918) 207-0078
(918) 207-0558
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
03/12/2015
Last updated
03/12/2015
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