Individual
TANYA REVELS
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
312 BARBARA ST, ARDMORE, OK 73401-9716
(580) 222-1528
Mailing address
312 BARBARA ST, ARDMORE, OK 73401-9716
(580) 222-1528
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
—
Other
Enumeration date
06/15/2009
Last updated
06/15/2009
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