Healthcare Provider Details

I. General information

NPI: 1275853301
Provider Name (Legal Business Name): COMMUNITY LEARNING COUNCIL, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2010
Last Update Date: 06/11/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 NW EXPRESSWAY SUITE 204
OKLAHOMA CITY OK
73112-7227
US

IV. Provider business mailing address

PO BOX 20414
OKLAHOMA CITY OK
73156-0414
US

V. Phone/Fax

Practice location:
  • Phone: 405-751-4219
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. GINGER DECOTEAU
Title or Position: FOUNDER, EXECUTIVE DIRECTOR
Credential: M.S., M.ED.
Phone: 405-751-4219