Individual
ANGEL ELLIS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
FSP
Contact information
Practice address
1803 S WOOD DR, OKMULGEE, OK 74447-6825
(918) 756-9250
(918) 756-9187
Mailing address
1803 S WOOD DR, OKMULGEE, OK 74447-6825
(918) 756-9250
(918) 756-9187
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/10/2014
Last updated
07/10/2014
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