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Individual

MR. EDWARD CLYDE SKIDMORE JR.

Active
Sole proprietor
Yes

Provider details

NPI number
Gender
Man
Credential
R.S.S.

Contact information

Practice address
417 COTTONWOOD ST, ARDMORE, OK 73401-1732
(580) 319-8402
Mailing address
PO BOX 1327, ARDMORE, OK 73402-1327
(580) 319-8402

Taxonomy

Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
101YM0800X
Mental Health Counselor
101YP1600X
Pastoral Counselor

Other

Enumeration date
11/02/2011
Last updated
11/02/2011
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