Healthcare Provider Details

I. General information

NPI: 1285398800
Provider Name (Legal Business Name): RAPHA COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2021
Last Update Date: 10/29/2021
Certification Date: 10/20/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

207 S CZECH HALL RD
YUKON OK
73099-6851
US

IV. Provider business mailing address

207 S CZECH HALL RD
YUKON OK
73099-6851
US

V. Phone/Fax

Practice location:
  • Phone: 405-405-1113
  • Fax:
Mailing address:
  • Phone: 405-826-8381
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: CARMEN PISCHEDDA
Title or Position: OWNER / THERAPIST
Credential:
Phone: 405-492-1113