Individual
MR. MITCHELL GENE DESHAZER
Active
Sole proprietor
No
Provider details
NPI number
Gender
Man
Contact information
Practice address
624 W INDEPENDENCE ST STE 113-115, SHAWNEE, OK 74804-4306
(405) 585-6413
Mailing address
624 W INDEPENDENCE ST STE 113-115, SHAWNEE, OK 74804-4306
(405) 585-6413
Taxonomy
Speciality
Code
Description
License number
State
106H00000X
Marriage & Family Therapist
Primary
—
OK
Other
Enumeration date
08/23/2017
Last updated
08/23/2017
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