Healthcare Provider Details

I. General information

NPI: 1568054690
Provider Name (Legal Business Name): REAL LIFE COMMUNICATION TRAINING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2021
Last Update Date: 02/10/2021
Certification Date: 02/10/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

312 NE 28TH ST STE 109A
OKLAHOMA CITY OK
73105-2822
US

IV. Provider business mailing address

3309 SIMMONS DR
OKLAHOMA CITY OK
73115-1865
US

V. Phone/Fax

Practice location:
  • Phone: 405-276-2496
  • Fax:
Mailing address:
  • Phone: 405-503-1043
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KATRINA RUSSHETTE RUSHING
Title or Position: OWNER/LICENSED THERAPIST
Credential: MHR, LPC
Phone: 405-276-2496