Organization
REVITALISONG HOPE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. BOBBY H. LONG (PRESIDENT)
(405) 831-3202
Entity
Organization
Contact information
Practice address
3321 IRON MOUND ROAD, GUTHRIE, OK 73044
(405) 831-3202
Mailing address
2231 IRON MOUND RD, GUTHRIE, OK 73044-5778
(405) 282-6305
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Enumeration date
05/13/2010
Last updated
05/13/2010
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