Healthcare Provider Details

I. General information

NPI: 1104268192
Provider Name (Legal Business Name): ELYSE SCHEIN
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 07/19/2013
Last Update Date: 07/19/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

127 N 3RD AVE
DURANT OK
74701-4700
US

IV. Provider business mailing address

PO BOX 48
MEAD OK
73449-0048
US

V. Phone/Fax

Practice location:
  • Phone: 580-931-3008
  • Fax: 580-931-8022
Mailing address:
  • Phone: 580-745-9610
  • Fax: 580-745-9891

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: