Basic Information
| Provider Information | |||||||||
| NPI: | 1558502922 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | TOTAL LIFE COUNSELING | ||||||||
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| Mailing Information | |||||||||
| Address1: | 3000 UNITED FOUNDERS BLVD STE 239 | ||||||||
| Address2: | |||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 731124294 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058407040 | ||||||||
| FaxNumber: | 4058407012 | ||||||||
| Practice Location | |||||||||
| Address1: | 3000 UNITED FOUNDERS BLVD. | ||||||||
| Address2: | SUITE 239 | ||||||||
| City: | OKLAHOMA CITY | ||||||||
| State: | OK | ||||||||
| PostalCode: | 73112 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4058407040 | ||||||||
| FaxNumber: | 4058407012 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/16/2009 | ||||||||
| LastUpdateDate: | 03/16/2009 | ||||||||
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| AuthorizedOfficialLastName: | PATTERSON | ||||||||
| AuthorizedOfficialFirstName: | LARRENDA | ||||||||
| AuthorizedOfficialMiddleName: | DEANEISHA | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 4058635724 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
| ParentOrganizationLBN: | |||||||||
| AuthorizedOfficialNamePrefix: | MS. | ||||||||
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| AuthorizedOfficialCredential: | MS, ADCIT,CM | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 171W00000X | Y | 193200000X MULTI-SPECIALTY GROUP | Other Service Providers | Contractor |
No ID Information.