Individual
ELIZABETH BALES
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
407 W SOUTH AVE, PONCA CITY, OK 74601
(580) 749-5056
Mailing address
407 W SOUTH AVE, PONCA CITY, OK 74601
(580) 749-5056
Taxonomy
Speciality
Code
Description
License number
State
171M00000X
Case Manager/Care Coordinator
Primary
—
—
175T00000X
Peer Specialist
—
—
Other
Enumeration date
04/21/2022
Last updated
04/25/2022
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