Basic Information
| Provider Information | |||||||||
| NPI: | 1649651324 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | INTEGRITY COUNSELING GROUP LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 115 S PETERS AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696065 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 115 S PETERS AVE | ||||||||
| Address2: | SUITE 11 | ||||||||
| City: | NORMAN | ||||||||
| State: | OK | ||||||||
| PostalCode: | 730696065 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4055351048 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/17/2015 | ||||||||
| LastUpdateDate: | 06/17/2015 | ||||||||
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| AuthorizedOfficialLastName: | BOSLEY | ||||||||
| AuthorizedOfficialFirstName: | TREBOR | ||||||||
| AuthorizedOfficialMiddleName: | WELLINGTON | ||||||||
| AuthorizedOfficialTitleorPosition: | CLINICAL DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 4055351048 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | MHR, LPC | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | Y | Agencies | Community/Behavioral Health |
No ID Information.