Healthcare Provider Details

I. General information

NPI: 1538282801
Provider Name (Legal Business Name): STILLWATER INTERFAITH COUNSELING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

306 W. 7TH STREET
STILLWATER OK
74074
US

IV. Provider business mailing address

306 W. 7TH ST.
STILLWATER OK
74074
US

V. Phone/Fax

Practice location:
  • Phone: 405-624-5840
  • Fax:
Mailing address:
  • Phone: 405-624-5840
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. CHERYL WICK
Title or Position: TREASURER
Credential:
Phone: 405-624-5840