Individual
MR. JOHNNY MARVELL LEAKE II
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
3621 N KELLEY AVE, OKLAHOMA CITY, OK 73111-4520
(405) 524-5525
Mailing address
3621 N KELLEY AVE, STE. 100, OKLAHOMA CITY, OK 73111-4520
(405) 524-5525
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
171W00000X
Contractor
—
—
Other
Enumeration date
01/27/2021
Last updated
01/28/2021
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