Individual
MS. MYSTI NICOLE EDGE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3010 NW 41ST ST, OKLAHOMA CITY, OK 73112-6256
(405) 819-8479
Mailing address
3010 NW 41ST ST, OKLAHOMA CITY, OK 73112-6256
(405) 819-8479
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
03/08/2016
Last updated
03/08/2016
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