Basic Information
| Provider Information | |||||||||
| NPI: | 1477856268 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | OKLAHOMA FAMILY COUNSELING SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 428 S MUSTANG RD | ||||||||
| Address2: | |||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730996754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055775477 | ||||||||
| FaxNumber: | 4055775488 | ||||||||
| Practice Location | |||||||||
| Address1: | 428 S MUSTANG RD | ||||||||
| Address2: | |||||||||
| City: | YUKON | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730996754 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055775477 | ||||||||
| FaxNumber: | 4055775488 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 12/16/2010 | ||||||||
| LastUpdateDate: | 12/16/2010 | ||||||||
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| AuthorizedOfficialLastName: | ALLEN | ||||||||
| AuthorizedOfficialFirstName: | SHANNA | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | THERAPIST | ||||||||
| AuthorizedOfficialTelephone: | 4055775477 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | MA,LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251B00000X | Y | Agencies | Case Management |
No ID Information.