Healthcare Provider Details

I. General information

NPI: 1790205664
Provider Name (Legal Business Name): VIZARC LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/22/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

IV. Provider business mailing address

700 NW 7TH ST
OKLAHOMA CITY OK
73102-1212
US

V. Phone/Fax

Practice location:
  • Phone: 405-553-1197
  • Fax: 405-553-1188
Mailing address:
  • Phone: 405-553-1197
  • Fax: 405-553-1188

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: AMY WOOLERY
Title or Position: VP OF THE ARC
Credential:
Phone: 405-553-1197