Individual
LATORIA PERRY
Active
Sole proprietor
No
Provider details
NPI number
Gender
F
Contact information
Practice address
117 W BROADWAY ST # 301, ARDMORE, OK 73401-6226
(580) 490-3371
Mailing address
1203 VERNON RD, ARDMORE, OK 73401-3653
(580) 798-6734
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
—
OK
Other
Enumeration date
10/17/2016
Last updated
10/17/2016
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