Healthcare Provider Details

I. General information

NPI: 1174812713
Provider Name (Legal Business Name): MOTIVATIONAL COUNSELING SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/05/2011
Last Update Date: 04/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4401 NW 4TH ST STE 123
OKLAHOMA CITY OK
73107-6540
US

IV. Provider business mailing address

4401 NW 4TH ST STE 123
OKLAHOMA CITY OK
73107-6540
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-1716
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GINA LUCILLE REDWINE
Title or Position: EXECUTIVE DIRECTOR
Credential: M.ED, BHRS,
Phone: 405-601-1716