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1083970289
PHILLIP M LAVENDER
ENID, OK
NPI
1083970289
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
Enumeration Date
2012-04-02
Last Update Date
2012-04-02
Business Address
-- PHILLIP M LAVENDER BHRS
1600 W WILLOW RD
ENID, OK 73703-2437
Phone number: 580-484-1018
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Mailing Address
-- PHILLIP M LAVENDER BHRS
1600 W WILLOW RD
ENID, OK 73703-2437
Phone number: 580-484-1018
Copy
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