Individual
JORDAN THOMAS
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
507 DEWEY AVE, POTEAU, OK 74953-4215
(918) 649-0172
Mailing address
2704 N BROADWAY ST, POTEAU, OK 74953-5402
(918) 649-0909
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
000000000
—
OK
Enumeration date
04/03/2017
Last updated
10/31/2022
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