Individual
MAZLIN GOFORTH
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
1300 HOPPE BLVD STE 3, ADA, OK 74820-2319
(405) 857-8280
Mailing address
1300 HOPPE BLVD STE 3, ADA, OK 74820-2319
Taxonomy
Speciality
Code
Description
License number
State
106S00000X
Behavior Technician
Primary
23-299534
OK
Other
Enumeration date
09/21/2023
Last updated
09/21/2023
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