Healthcare Provider Details

I. General information

NPI: 1003386418
Provider Name (Legal Business Name): A PLUS CARE PROGRAM LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2018
Last Update Date: 12/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

123 E AVENUE C
HEAVENER OK
74937-2603
US

IV. Provider business mailing address

123 E AVENUE C STE B
HEAVENER OK
74937-2603
US

V. Phone/Fax

Practice location:
  • Phone: 918-658-4016
  • Fax:
Mailing address:
  • Phone: 918-658-4016
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 5
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: CONNIE M RAY
Title or Position: CEO
Credential: MS, MED, LPC, LADC
Phone: 918-658-4016