Healthcare Provider Details

I. General information

NPI: 1205275351
Provider Name (Legal Business Name): THE OASIS COUNSELING CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/21/2013
Last Update Date: 10/10/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1531 ROCKFORD CT
KOKOMO IN
46902-3207
US

IV. Provider business mailing address

1531 ROCKFORD CT
KOKOMO IN
46902-3207
US

V. Phone/Fax

Practice location:
  • Phone: 765-453-4500
  • Fax: 765-453-4525
Mailing address:
  • Phone: 765-453-4500
  • Fax: 765-453-4525

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateIN
# 2
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code364SP0808X
TaxonomyPsychiatric/Mental Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. ANGELA M ROEGNER
Title or Position: OWNER
Credential: LCSW
Phone: 765-453-4500