Individual
MICHAEL JAMES ELLISON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
BS EDUCATION
Contact information
Practice address
703 FRISCO AVE, CLINTON, OK 73601-3320
(580) 323-9100
(580) 323-9101
Mailing address
703 FRISCO AVE, CLINTON, OK 73601-3320
(580) 323-9100
(580) 323-9101
Taxonomy
Speciality
Code
Description
License number
State
104100000X
Social Worker
Primary
—
—
Other
Enumeration date
05/14/2010
Last updated
05/14/2010
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