Individual
POLLY WILSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
2502 CROSSROADS DR, B, ARDMORE, OK 73401-2503
(580) 226-4800
Mailing address
2502 CROSSROADS DR, B, ARDMORE, OK 73401-2503
(580) 226-4800
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
1582
OK
Other
Enumeration date
06/08/2011
Last updated
06/08/2011
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