Healthcare Provider Details

I. General information

NPI: 1093608499
Provider Name (Legal Business Name): TRANSFORMATIONAL COUNSELING AND LIFE COACHING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/03/2025
Last Update Date: 06/03/2025
Certification Date: 06/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 321
OKLAHOMA CITY OK
73106-6834
US

IV. Provider business mailing address

2209 ALDERHAM AVE
OKLAHOMA CITY OK
73170-3209
US

V. Phone/Fax

Practice location:
  • Phone: 405-265-6575
  • Fax: 405-913-1444
Mailing address:
  • Phone: 405-230-0173
  • Fax: 405-913-1444

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: SHANDALYN DUBLIN
Title or Position: DIRECTOR
Credential: LPC
Phone: 405-230-0173