Healthcare Provider Details

I. General information

NPI: 1730334996
Provider Name (Legal Business Name): SIGNATURE TRANSFORMATION COUNSELING SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/01/2008
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

433 WILSHIRE BOULEVARD SUITE B
OKLAHOMA CITY OK
73116-7777
US

IV. Provider business mailing address

433 WILSHIRE BOULEVARD SUITE B
OKLAHOMA CITY OK
73116
US

V. Phone/Fax

Practice location:
  • Phone: 405-824-9252
  • Fax:
Mailing address:
  • Phone: 405-824-9252
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number3606
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number3606
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3606
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number3606
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3606
License Number StateOK
# 6
Primary TaxonomyN
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number3606
License Number StateOK
# 7
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 8
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MISS JEANETTE M SMITH
Title or Position: EXECUTIVE DIRECTOR
Credential: MA
Phone: 405-242-5082