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General NPI Number Information
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NPI Number | 1003634080
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Entity Type | Organization
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Legal Business Name | PATRICK'S SYCAMOORE COUNSELING LLC
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Dates
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Enumeration Date | 09/30/2024
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Last Update Date | 09/30/2024
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Provider Practice Location Address
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Address Line | 3908 N PENIEL AVE STE 500
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City | BETHANY
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State | OK
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Zip | 73008-3402
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Country | US
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Telephone | 405-603-3265
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Fax |
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Provider Business Mailing Address
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Address Line | 3508 GRIZZLY RIDGE CT
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City | YUKON
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State | OK
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Zip | 73099-3576
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Country | US
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Telephone | 405-816-0343
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | PATRICK JAMES MOORE
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Credential | LPC
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Telephone | 405-816-0343
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number |
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License Number State |
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