Individual
MR. MICCO LEWIS FREEMAN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
3441 E ARCHER ST, TULSA, OK 74115-8217
(918) 833-8650
Mailing address
11740 E 21ST ST, TULSA, OK 74129-1820
(918) 841-5065
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
NONE
—
171M00000X
Case Manager/Care Coordinator
—
—
Other
Enumeration date
06/16/2015
Last updated
01/23/2020
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