Individual
MR. ANDRE GREGROLLE JOHN CAMPBELL
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Credential
M.A.,LMFT.LADC.
Contact information
Practice address
2510 EAST 15TH STREET, SUITE 205, TULSA, OK 74104
(918) 508-2750
(918) 744-4432
Mailing address
2510 E. 15TH ST., TULSA, OK 74104
(918) 508-2750
(918) 744-4432
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
968
OK
106H00000X
Marriage & Family Therapist
Primary
997
OK
Other
Enumeration date
07/01/2009
Last updated
07/19/2012
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