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Individual

CYNTHIA LYNN SISSOM

Active
Sole proprietor
No

Provider details

NPI number
Gender
F
Credential
LADC

Contact information

Practice address
316 E LEE AVE, SAPULPA, OK 74066-4306
(918) 227-9890
Mailing address
PO BOX 927, SAPULPA, OK 74067-0927
(918) 227-9890

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
669
OK

Other

Enumeration date
03/18/2009
Last updated
03/18/2009
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