Healthcare Provider Details

I. General information

NPI: 1265964308
Provider Name (Legal Business Name): PHOENIX COUNSELING AND ASSESSMENT CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2017
Last Update Date: 04/02/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

32 E CHEROKEE SUITE 104
MCALESTER OK
74501
US

IV. Provider business mailing address

32 E CHEROKEE AVE SUITE 104
MCALESTER OK
74501-5323
US

V. Phone/Fax

Practice location:
  • Phone: 918-423-9400
  • Fax:
Mailing address:
  • Phone: 918-423-9400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: ALICE R BECKHAM
Title or Position: DIRECTOR
Credential: MS, LPC, CADCU/S
Phone: 918-423-9400