Healthcare Provider Details

I. General information

NPI: 1386578169
Provider Name (Legal Business Name): INTEGRATIVE COUNSELING OF OKLAHOMA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2026
Last Update Date: 06/09/2026
Certification Date: 06/09/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2529 S KELLY AVE STE C
EDMOND OK
73013-2976
US

IV. Provider business mailing address

2529 S KELLY AVE STE C
EDMOND OK
73013-2976
US

V. Phone/Fax

Practice location:
  • Phone: 405-615-4860
  • Fax: 405-562-1976
Mailing address:
  • Phone: 405-615-4860
  • Fax: 405-562-1976

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. JENNIFER NICOLE BRONSON
Title or Position: LICENSED PROFESSIONAL COUNSELOR
Credential: MA. LPC-S
Phone: 405-615-4860