Individual
AUDRA ULLOM
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
MFT
Contact information
Practice address
1510 INDIAN DR, ENID, OK 73703-7013
(785) 821-2497
Mailing address
1510 INDIAN DR, ENID, OK 73703-5653
(785) 821-2497
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
—
Other
Enumeration date
08/28/2016
Last updated
08/28/2016
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