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1952438293
LISA DIANE DIETZ
PONCA CITY, OK
NPI
1952438293
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Entity Type
Individual
Gender
Female
Sole Proprietor ?
Yes
Primary Taxonomy
101YM0800X Counselor, Mental Health
(Licence: OK 1642)
Enumeration Date
2007-02-27
Last Update Date
2007-07-08
Business Address
Mr. LISA DIANE DIETZ M.S.
222 E GRAND AVE SUITE 404
PONCA CITY, OK 74601-4316
Phone number: 580-763-2256
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Mailing Address
Mr. LISA DIANE DIETZ M.S.
222 E GRAND AVE SUITE 404
PONCA CITY, OK 74601-4316
Phone number: 580-763-2256
Copy
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