Individual
MR. SHELLY J LARSON
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Credential
CADC
Contact information
Practice address
2 WICKERSHAM ST, MANGUM, OK 73554-9117
(580) 782-3337
(580) 782-3337
Mailing address
2 WICKERSHAM ST, MANGUM, OK 73554-9117
(580) 782-3337
(580) 782-3337
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
256
OK
Other
Enumeration date
05/16/2007
Last updated
07/08/2007
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