Individual
MICHAELA RUSSELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
2525 NW EXPRESSWAY, OKLAHOMA CITY, OK 73112
(405) 242-5031
Mailing address
2509 SE 49TH ST, OKLAHOMA CITY, OK 73129
(405) 414-7275
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
OK
Other
Enumeration date
01/06/2017
Last updated
01/06/2017
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