Healthcare Provider Details

I. General information

NPI: 1467966952
Provider Name (Legal Business Name): DANCING HAWK COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/20/2017
Last Update Date: 11/20/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

118 W BROADWAY ST
ALTUS OK
73521-3816
US

IV. Provider business mailing address

512 QUAIL RUN N
ALTUS OK
73521-9723
US

V. Phone/Fax

Practice location:
  • Phone: 580-379-4900
  • Fax: 580-379-4921
Mailing address:
  • Phone: 580-379-4900
  • Fax: 580-379-4921

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2729
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number129
License Number StateOK

VIII. Authorized Official

Name: MRS. KRISTINA LYNN MCKUNE
Title or Position: OWNER/ PROFESSIONAL COUNSELOR
Credential: M.S., LPC, LADC
Phone: 580-379-4900