JIMMY TODD SELF

WAGONER, OK
NPI1528171022
Entity TypeIndividual
GenderMale
Sole Proprietor ?Yes
Primary Taxonomy101YM0800X Counselor, Mental Health
(Licence: OK  3651)
Enumeration Date2006-08-17
Last Update Date2009-03-30
Business Address
Mr. JIMMY TODD SELF LPC
32270 E 722 DR
WAGONER, OK 74467-7411
Phone number: 918-485-9277
Mailing Address
Mr. JIMMY TODD SELF LPC
32270 E 722 DR
WAGONER, OK 74467-7411
Phone number: 918-485-9277
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