Individual
EBONY SHIRLEY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
1505 NE 3RD ST, MOORE, OK 73160-7811
(214) 250-8582
Mailing address
1505 NE 3RD ST, MOORE, OK 73160-7811
(214) 250-8582
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
02/11/2014
Last updated
02/11/2014
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