Individual
LEERISA FREDERICK
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
416 S MUSTANG RD STE B, YUKON, OK 73099-7314
(405) 494-0644
Mailing address
416 S MUSTANG RD STE B, YUKON, OK 73099-7314
(405) 448-6163
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
10584
—
Other
Enumeration date
03/19/2019
Last updated
12/08/2023
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