Healthcare Provider Details

I. General information

NPI: 1962116384
Provider Name (Legal Business Name): COURTNEY SCROGGINS LPC CANDIDATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/10/2023
Last Update Date: 09/29/2026
Certification Date: 09/29/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1336 N HARRISON AVE
SHAWNEE OK
74801-5206
US

IV. Provider business mailing address

15957 PECAN RD
MCLOUD OK
74851-3300
US

V. Phone/Fax

Practice location:
  • Phone: 405-275-7100
  • Fax:
Mailing address:
  • Phone: 918-530-5337
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number12463
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: