Healthcare Provider Details

I. General information

NPI: 1720206766
Provider Name (Legal Business Name): FAMILY RECOVERY COUNSELING CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/15/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4801 N CLASSEN BLVD SUITE 153
OKLAHOMA CITY OK
73118-4627
US

IV. Provider business mailing address

4801 N CLASSEN BLVD SUITE 153
OKLAHOMA CITY OK
73118-4627
US

V. Phone/Fax

Practice location:
  • Phone: 405-879-2282
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DAN R. STEVENS
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 405-879-2282