Individual
GRACE MUKOMBE
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Contact information
Practice address
3400 DESKIN DR # 8295, NORMAN, OK 73069-8295
(405) 701-8530
(405) 701-8529
Mailing address
820 N EMERSON ST, JENKS, OK 74037-3828
(918) 510-2958
Taxonomy
Speciality
Code
Description
License number
State
322D00000X
Emotionally Disturbed Childrens' Residential Treatment Facility
Primary
—
—
Other
Enumeration date
09/12/2021
Last updated
09/12/2021
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