Individual
THERON OGEDENGBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
227 N WATER AVE, TAHLEQUAH, OK 74464-2825
(918) 207-0078
Mailing address
1330 E ALLEN RD APT 9, TAHLEQUAH, OK 74464-2255
(918) 934-0348
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
—
—
Other
Enumeration date
03/28/2016
Last updated
03/28/2016
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