Healthcare Provider Details

I. General information

NPI: 1437651908
Provider Name (Legal Business Name): FAITH OVER FEAR COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2018
Last Update Date: 03/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1909 MAIN ST
WOODWARD OK
73801-2942
US

IV. Provider business mailing address

501 EDGEWATER DR
WOODWARD OK
73801-6903
US

V. Phone/Fax

Practice location:
  • Phone: 580-334-6167
  • Fax:
Mailing address:
  • Phone: 580-334-6167
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number987
License Number StateOK
# 2
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number987
License Number StateOK
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number987
License Number StateOK

VIII. Authorized Official

Name: COURTNEY RENEE LAWELLIN
Title or Position: COUNSELOR
Credential: LADC/MH
Phone: 580-334-6167