Healthcare Provider Details

I. General information

NPI: 1437636123
Provider Name (Legal Business Name): OIKOS REALITIE TRADE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/25/2018
Last Update Date: 07/25/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4211 N MACARTHUR BLVD STE A
WARR ACRES OK
73122-3007
US

IV. Provider business mailing address

4211 N MACARTHUR BLVD STE A
WARR ACRES OK
73122-3007
US

V. Phone/Fax

Practice location:
  • Phone: 405-589-3965
  • Fax:
Mailing address:
  • Phone: 405-589-3965
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StateOK
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateOK
# 4
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateOK
# 5
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number State

VIII. Authorized Official

Name: MRS. JEANETTE RIVERA
Title or Position: OWNER
Credential:
Phone: 405-589-3965