Healthcare Provider Details

I. General information

NPI: 1215857784
Provider Name (Legal Business Name): EMOTIONAL INTELLIGENT THERAPEUTIC SERVICES PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/16/2026
Last Update Date: 07/16/2026
Certification Date: 07/16/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1330 N CLASSEN BLVD STE 125
OKLAHOMA CITY OK
73106-6834
US

IV. Provider business mailing address

1330 N CLASSEN BLVD STE 125
OKLAHOMA CITY OK
73106-6834
US

V. Phone/Fax

Practice location:
  • Phone: 405-210-2073
  • Fax:
Mailing address:
  • Phone: 405-254-7184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: MYQUICHE CLAYTON SR.
Title or Position: MANAGING CLINICAL DIRECTOR
Credential: LPC SUPERVISOR
Phone: 405-210-2073