Individual
LISA AVERY
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
6333 E SKELLY DR, TULSA, OK 74135-6106
(918) 508-9212
Mailing address
6333 E SKELLY DR, TULSA, OK 74135-6106
Taxonomy
Speciality
Code
Description
License number
State
324500000X
Substance Abuse Rehabilitation Facility
Primary
—
—
Other
Enumeration date
07/16/2012
Last updated
07/16/2012
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