MEDICARE: BIG SKY COUNSELING, INC

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	1041C0700X	Clinical Social Worker	3871	OK

General Provider Information

NPI Number	:	1629322128
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	BIG SKY COUNSELING, INC

Provider Business Mailing Address
First Line	:	5009 N PENNSYLVANIA AVE
Second Line	:	STE 105
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8887
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	5009 N PENNSYLVANIA AVE
Second Line	:	STE 105
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73112-8887
Country	:	US
Telephone Number	:	405-761-2514
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	ELIZABETH FLETCHER-BROWN
Credential	:	LCSW
Telephone Number	:	405-761-2514

Provider Enumeration Date	:	11/05/2012
Last Update Date	:	11/05/2012

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