Healthcare Provider Details

I. General information

NPI: 1386169969
Provider Name (Legal Business Name): BIG LOVE COUNSELING AND WELLNESS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/04/2017
Last Update Date: 08/04/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1210 ROOSEVELT ST STE 220
EDMOND OK
73034-5176
US

IV. Provider business mailing address

777 E 15TH ST APT 250
EDMOND OK
73013-5016
US

V. Phone/Fax

Practice location:
  • Phone: 405-655-8865
  • Fax:
Mailing address:
  • Phone: 405-655-8865
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SANDRA M SABBIONI
Title or Position: OWNER/PRESIDENT
Credential: L.C.S.W.
Phone: 405-655-8865