Healthcare Provider Details

I. General information

NPI: 1457791832
Provider Name (Legal Business Name): CDT COUNSELING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2013
Last Update Date: 06/28/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6506 STONE VALLEY DR
EDMOND OK
73034-9558
US

IV. Provider business mailing address

6506 STONE VALLEY DR
EDMOND OK
73034-9558
US

V. Phone/Fax

Practice location:
  • Phone: 405-226-5273
  • Fax:
Mailing address:
  • Phone: 405-226-5273
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number5437
License Number StateOK

VIII. Authorized Official

Name: MRS. CANDACE D. TUCKER
Title or Position: MEMBER
Credential: LPC
Phone: 405-226-5273