Individual
JEROME LATRAY PHILLIPS
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Credential
B.S, BHRS
Contact information
Practice address
5400 WILLOW CLIFF RD APT 436, OKLAHOMA CITY, OK 73122-6341
(405) 789-0168
Mailing address
5400 WILLOW CLIFF RD APT 436, OKLAHOMA CITY, OK 73122-6341
(405) 789-0168
Taxonomy
Speciality
Code
Description
License number
State
103TR0400X
Rehabilitation Psychologist
Primary
S082659956
OK
Other
Enumeration date
09/26/2011
Last updated
09/26/2011
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