Healthcare Provider Details

I. General information

NPI: 1114299534
Provider Name (Legal Business Name): CODY WAYNE GROVES MS, LPC CANDIDATE
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/31/2012
Last Update Date: 03/03/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

222 E SHERIDAN AVE
OKLAHOMA CITY OK
73104-4233
US

IV. Provider business mailing address

222 E SHERIDAN AVE
OKLAHOMA CITY OK
73104-4233
US

V. Phone/Fax

Practice location:
  • Phone: 866-926-6552
  • Fax:
Mailing address:
  • Phone: 866-926-6552
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: