Healthcare Provider Details

I. General information

NPI: 1245543750
Provider Name (Legal Business Name): SILVER LEAF COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/26/2010
Last Update Date: 07/26/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

604 S CLASSEN AVE SUITE C
MOORE OK
73160-5401
US

IV. Provider business mailing address

2621 SW 93RD ST
OKLAHOMA CITY OK
73159-6714
US

V. Phone/Fax

Practice location:
  • Phone: 405-822-2211
  • Fax: 405-212-4723
Mailing address:
  • Phone: 405-822-2211
  • Fax: 405-212-4723

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2793
License Number StateOK

VIII. Authorized Official

Name: MS. ANGELA J ANDERSON
Title or Position: OWNER
Credential: LCSW
Phone: 405-822-2211