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1497312516
TRENTON D FEDRICK
TULSA, OK
NPI
1497312516
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Entity Type
Individual
Gender
Male
Sole Proprietor ?
Yes
Primary Taxonomy
101YA0400X Counselor, Addiction (Substance Use Disorder)
(Licence: IL 14583)
Enumeration Date
2019-05-23
Last Update Date
2019-05-23
Business Address
TRENTON D FEDRICK
550 S PEORIA AVE
TULSA, OK 74120-3820
Phone number: 918-588-1900
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Mailing Address
TRENTON D FEDRICK
6500 N GLENWOOD AVE APT 103
CHICAGO, IL 60626-5154
Phone number: 773-386-4833
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