Healthcare Provider Details

I. General information

NPI: 1003163296
Provider Name (Legal Business Name): AFFINITY COUNSELING SERCIVES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/07/2012
Last Update Date: 08/07/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

632 W. CENTRAL
CARNEY OK
74832
US

IV. Provider business mailing address

PO BOX 57
CARNEY OK
74832-0057
US

V. Phone/Fax

Practice location:
  • Phone: 405-612-3121
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number4551
License Number StateOK

VIII. Authorized Official

Name: PAULA KNOX
Title or Position: EXECUTIVE DIRECTOR/OWNER
Credential: LPC
Phone: 405-612-3121