Healthcare Provider Details

I. General information

NPI: 1376719716
Provider Name (Legal Business Name): WICHITA COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/06/2008
Last Update Date: 05/06/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6217 W GORE BLVD
LAWTON OK
73505-5836
US

IV. Provider business mailing address

6217 W GORE BLVD
LAWTON OK
73505-5836
US

V. Phone/Fax

Practice location:
  • Phone: 580-353-4357
  • Fax: 580-536-5102
Mailing address:
  • Phone: 580-353-4357
  • Fax: 580-536-5102

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number3569
License Number StateOK

VIII. Authorized Official

Name: MS. ARLETA SPYCE STOVER
Title or Position: OWNER
Credential: LPC
Phone: 580-383-4357