Individual
THERESA MARCELES CONNELLY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
351 N AIR DEPOT BLVD, SUITE S, MIDWEST CITY, OK 73110-1700
(405) 610-6540
Mailing address
5613 N HIWASSEE RD, SPENCER, OK 73084-9413
(405) 610-6540
(405) 610-6563
Taxonomy
Speciality
Code
Description
License number
State
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
Primary
—
OK
Other
Enumeration date
04/05/2012
Last updated
04/05/2012
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