Healthcare Provider Details

I. General information

NPI: 1790112647
Provider Name (Legal Business Name): RED ROAD COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2013
Last Update Date: 12/09/2025
Certification Date: 12/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1004 CHOCTAW RIDGE RD
MIDWEST CITY OK
73130-6127
US

IV. Provider business mailing address

1139 36TH AVE NW STE 200
NORMAN OK
73072-4113
US

V. Phone/Fax

Practice location:
  • Phone: 405-990-0816
  • Fax:
Mailing address:
  • Phone: 405-990-0816
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: CECILIA M. MADONNA
Title or Position: DIRECTOR OF OPERATIONS
Credential:
Phone: 405-990-0816