Healthcare Provider Details

I. General information

NPI: 1063939247
Provider Name (Legal Business Name): JUST A STEP COUNSELING, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2017
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 VINEYARD BLVD STE A
OKLAHOMA CITY OK
73120-3830
US

IV. Provider business mailing address

10400 VINEYARD BLVD STE A
OKLAHOMA CITY OK
73120-3830
US

V. Phone/Fax

Practice location:
  • Phone: 405-242-5305
  • Fax: 405-242-5345
Mailing address:
  • Phone: 405-242-5305
  • Fax: 405-242-5345

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number6461
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number6461
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number6461
License Number StateOK

VIII. Authorized Official

Name: MR. DEREK SAMUEL THOMASON
Title or Position: COUNSELOR/OWNER
Credential: LPC
Phone: 501-551-1943