MEDICARE: LEOPARD PRINT THERAPY GROUP LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1053059337
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	LEOPARD PRINT THERAPY GROUP LLC

Provider Business Mailing Address
First Line	:	2200 N CLASSEN BLVD STE 702
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5806
Country	:	US
Telephone Number	:	405-503-7930
Fax Number	:

Provider Business Practice Location Address
First Line	:	2200 N CLASSEN BLVD STE 702
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73106-5806
Country	:	US
Telephone Number	:	405-503-7930
Fax Number	:

Authorized Official
Title or Position	:	LPC
Name	:	SHERITA GIBSON
Credential	:
Telephone Number	:	405-503-7930

Provider Enumeration Date	:	05/25/2022
Last Update Date	:	05/25/2022

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Directions to “LEOPARD PRINT THERAPY GROUP LLC ” Practice Location

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