Individual
LARISSA WILSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
9112 ROLLING GREEN AVE, OKLAHOMA CITY, OK 73132-2055
(405) 249-6436
Mailing address
9112 ROLLING GREEN AVE, OKLAHOMA CITY, OK 73132-2055
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
10/13/2020
Last updated
10/13/2020
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