Individual
MICKI MELINDA FOUSE
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
608 HIGHWAY 271 N, ANTLERS, OK 74523-2055
(580) 298-5062
(580) 298-5072
Mailing address
RR 2 BOX 989, VALLIANT, OK 74764-9761
(580) 298-5062
(580) 298-5072
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
09/16/2010
Last updated
09/16/2010
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