Healthcare Provider Details

I. General information

NPI: 1255661906
Provider Name (Legal Business Name): TOTAL LIFE COUNSELING FOUNDATION
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/31/2009
Last Update Date: 12/31/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 UNITED FOUNDERS BLVD 239
OKLAHOMA CITY OK
73112-3958
US

IV. Provider business mailing address

3000 UNITED FOUNDERS BLVD 239
OKLAHOMA CITY OK
73112-3958
US

V. Phone/Fax

Practice location:
  • Phone: 405-840-7040
  • Fax:
Mailing address:
  • Phone: 405-840-7040
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. KATHLEEN ANNE KENNEDY
Title or Position: COUNSELOR
Credential: MSCP
Phone: 405-840-7040