Healthcare Provider Details

I. General information

NPI: 1578867891
Provider Name (Legal Business Name): THERAPEUTIC ALLIANCES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

5839 HEFNER VILLAGE CT
OKLAHOMA CITY OK
73162-7755
US

IV. Provider business mailing address

5839 HEFNER VILLAGE CT
OKLAHOMA CITY OK
73162-7755
US

V. Phone/Fax

Practice location:
  • Phone: 405-384-1136
  • Fax:
Mailing address:
  • Phone: 405-384-1136
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number604
License Number StateOK

VIII. Authorized Official

Name: REX FRYER
Title or Position: OWNER
Credential: LPC
Phone: 405-384-1136