Healthcare Provider Details

I. General information

NPI: 1457582280
Provider Name (Legal Business Name): TURTLE MOUNTAIN COUSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/28/2009
Last Update Date: 07/28/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1225 W MAIN ST SUITE 102
NORMAN OK
73069-6824
US

IV. Provider business mailing address

1225 W MAIN ST SUITE 102
NORMAN OK
73069-6824
US

V. Phone/Fax

Practice location:
  • Phone: 405-292-1000
  • Fax: 405-801-2506
Mailing address:
  • Phone: 405-292-1000
  • Fax: 405-801-2506

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code302F00000X
TaxonomyExclusive Provider Organization
License Number4156
License Number StateOK

VIII. Authorized Official

Name: MRS. ELIZABETH CHYLENE DELARRE
Title or Position: OWNER/PRESIDENT
Credential: LPC
Phone: 405-292-1000