MEDICARE: AT EASE COUNSELING SERVICES, PLLC

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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1336972272
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AT EASE COUNSELING SERVICES, PLLC

Provider Business Mailing Address
First Line	:	5601 NW 72ND ST STE 234
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-5920
Country	:	US
Telephone Number	:	405-822-4372
Fax Number	:	405-349-4433

Provider Business Practice Location Address
First Line	:	5601 NW 72ND ST STE 234
Second Line	:
City	:	WARR ACRES
State	:	OK
Zip	:	73132-5920
Country	:	US
Telephone Number	:	405-822-4372
Fax Number	:	405-349-4433

Authorized Official
Title or Position	:	OWNER
Name	:	MICHAEL S RADONSKI
Credential	:	LCSW
Telephone Number	:	405-822-4372

Provider Enumeration Date	:	08/26/2024
Last Update Date	:	09/13/2024

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