Individual
TERRY WOMACK
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
5131 CLASSEN CIR, OKLAHOMA CITY, OK 73118-4418
(405) 767-1126
Mailing address
5416 SHALIMAR DR, OKLAHOMA CITY, OK 73135-1530
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
080204251
—
OK
Enumeration date
10/04/2011
Last updated
10/04/2011
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