Organization
PROVIDENCE SERVICE CORPORATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. AGLAIA 'ALEXIS' MARTIN LPC (THERAPIST)
(580) 355-6800
Entity
Organization
Contact information
Practice address
4645 W GORE BLVD, SUITE 5, LAWTON, OK 73505-6041
(580) 355-6800
Mailing address
4645 W GORE BLVD, SUITE 5, LAWTON, OK 73505-6041
(580) 355-6800
Taxonomy
Speciality
Code
Description
License number
State
251K00000X
Public Health or Welfare Agency
Primary
2560
OK
Other
Enumeration date
07/30/2006
Last updated
08/22/2020
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