Healthcare Provider Details

I. General information

NPI: 1336058361
Provider Name (Legal Business Name): SGILLIAMCOUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/04/2026
Last Update Date: 09/04/2026
Certification Date: 09/04/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4140 W MEMORIAL RD STE 413
OKLAHOMA CITY OK
73120-8300
US

IV. Provider business mailing address

4140 W MEMORIAL RD STE 413
OKLAHOMA CITY OK
73120-8300
US

V. Phone/Fax

Practice location:
  • Phone: 405-210-8184
  • Fax:
Mailing address:
  • Phone: 405-210-8184
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: STEPHANIE GILLIAM
Title or Position: MENTAL HEALTH COUNSELOR
Credential: LPC
Phone: 405-210-8184