Individual
LAVORDA FOREST
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
1712 YELLOWSTONE LN, EDMOND, OK 73003-4673
(405) 229-3681
Mailing address
1712 YELLOWSTONE LN, EDMOND, OK 73003-4673
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
01/09/2009
Last updated
01/09/2009
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