Individual
LORDLY BEARD
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
Man
Contact information
Practice address
610 N EMERSON ST, JENKS, OK 74037-3805
(918) 949-0797
Mailing address
610 N EMERSON ST, JENKS, OK 74037-3805
(918) 949-0797
Taxonomy
Speciality
Code
Description
License number
State
101Y00000X
Counselor
Primary
082981852
OK
Other
Enumeration date
05/26/2016
Last updated
05/26/2016
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