Healthcare Provider Details

I. General information

NPI: 1992113955
Provider Name (Legal Business Name): REACH FOR THE LIGHT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2014
Last Update Date: 07/23/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1418 LINWOOD BLVD
OKLAHOMA CITY OK
73106-5022
US

IV. Provider business mailing address

1418 LINWOOD BLVD
OKLAHOMA CITY OK
73106-5022
US

V. Phone/Fax

Practice location:
  • Phone: 405-601-0295
  • Fax: 405-601-0316
Mailing address:
  • Phone: 405-601-0295
  • Fax: 405-601-0316

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number516
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number835
License Number StateOK

VIII. Authorized Official

Name: CAROLYN J GREENWOOD
Title or Position: CLINICAL DIRECTOR
Credential: LMFT, LADC, ICADC
Phone: 405-601-0295