Healthcare Provider Details

I. General information

NPI: 1821640095
Provider Name (Legal Business Name): OVERCROSS COUNSELING AND EQUINE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/09/2019
Last Update Date: 11/08/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9565 HIGHWAY 75
PRESTON OK
74456-5600
US

IV. Provider business mailing address

PO BOX 189
PRESTON OK
74456-0189
US

V. Phone/Fax

Practice location:
  • Phone: 918-978-5038
  • Fax:
Mailing address:
  • Phone: 918-978-5038
  • 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: KIMBERLY WHAYNE
Title or Position: THERAPIST
Credential: LPC
Phone: 918-978-5038