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Individual

CLINTON HILL

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man

Contact information

Practice address
201 S MURRAY ST, TISHOMINGO, OK 73460-2224
(580) 371-0321
(580) 371-0131
Mailing address
7575 W 106TH ST, APT 138, OVERLAND PARK, KS 66212-5920
(620) 381-0351

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary

Other

Enumeration date
04/28/2014
Last updated
04/28/2014
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