Individual
DERICK ALLEN EIDSON
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
19108 COUNTY ROAD 3560, ADA, OK 74820-0177
(580) 421-1800
Mailing address
19108 COUNTY ROAD 3560, ADA, OK 74820-0177
(580) 421-1800
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
—
Other
Enumeration date
07/25/2013
Last updated
07/25/2013
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