Healthcare Provider Details

I. General information

NPI: 1699854836
Provider Name (Legal Business Name): OASIS COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/06/2006
Last Update Date: 12/14/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1030 SHIVE LN
BOWLING GREEN KY
42103-8037
US

IV. Provider business mailing address

PO BOX 51247
BOWLING GREEN KY
42102-5547
US

V. Phone/Fax

Practice location:
  • Phone: 270-943-1851
  • Fax:
Mailing address:
  • Phone: 270-943-1851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number StateNULL

VIII. Authorized Official

Name: TAMARA L BRUCATO
Title or Position: PROGRAM MANAGER
Credential:
Phone: 270-943-1851