Individual
KELLY STANDINGWATER
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3100 S ELM PL STE B, BROKEN ARROW, OK 74012-7950
(918) 286-2535
(918) 286-7693
Mailing address
3100 S ELM PL STE B, BROKEN ARROW, OK 74012-7950
(918) 286-2535
(918) 286-7693
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
—
—
Other
Enumeration date
11/10/2010
Last updated
11/10/2010
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