Individual
MR. MANOTE PROMMART
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1101 S 33RD ST, BROKEN ARROW, OK 74014-2929
(918) 497-8806
Mailing address
1101 S 33RD ST, BROKEN ARROW, OK 74014-2929
(918) 497-8806
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
100708360B
—
OK
Enumeration date
01/25/2010
Last updated
01/25/2010
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