JOHNNY MARVELL LEAKE

OKLAHOMA CITY, OK
NPI1588255194
Entity TypeIndividual
GenderMale
Sole Proprietor ?No
Primary Taxonomy101YA0400X Counselor Addiction (Substance Use Disorder)
Additional Taxonomies171W00000X Contractor
Enumeration Date2021-01-27
Last Update Date2021-01-28
Business Address
MR. JOHNNY MARVELL LEAKE
3621 N KELLEY AVE
OKLAHOMA CITY, OK 73111-4520
Phone number: 405-524-5525
Mailing Address
MR. JOHNNY MARVELL LEAKE
3621 N KELLEY AVE STE. 100
OKLAHOMA CITY, OK 73111-4520
Phone number: 405-524-5525
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