Healthcare Provider Details

I. General information

NPI: 1609357714
Provider Name (Legal Business Name): MR. JOHN PLEAS HOUSTON
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/27/2018
Last Update Date: 08/27/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

804 W CHOCTAW AVE
CHICKASHA OK
73018-2310
US

IV. Provider business mailing address

8301 N COUCIL RD APT 406
OKLAHOMA CITY OK
73123
US

V. Phone/Fax

Practice location:
  • Phone: 405-222-0622
  • Fax:
Mailing address:
  • Phone: 580-768-9331
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: