MEDICARE: MOTIVATIONAL COUNSELING SERVICES, 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	251S00000X	Community/Behavioral Health Agency
2	251B00000X	Case Management Agency

General Provider Information

NPI Number	:	1174812713
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOTIVATIONAL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	4401 NW 4TH ST STE 123
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-6540
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4401 NW 4TH ST STE 123
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73107-6540
Country	:	US
Telephone Number	:	405-601-1716
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MS. GINA LUCILLE REDWINE
Credential	:	M.ED, BHRS,
Telephone Number	:	405-601-1716

Provider Enumeration Date	:	04/05/2011
Last Update Date	:	04/05/2011

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