Individual
JOEL RUSSELL WINGO
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
GRAND LAKE MENTAL HEALTH CENTER INC., 604 S. WALNUT ST., STILLWATER, OK 74074-4222
(918) 857-6280
Mailing address
GRAND LAKE MENTAL HEALTH CENTER, INC, 604 SOUTH WALNUT, STILLWATER, OK 74074-4222
(918) 857-6280
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
Other
Enumeration date
11/08/2019
Last updated
11/08/2019
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