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General NPI Number Information
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NPI Number | 1033582994
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Entity Type | Organization
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Legal Business Name | ISAIAH COUNSELING LLC
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 04/17/2017
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Provider Practice Location Address
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Address Line | 305 E RAY FINE BLVD STE 3
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City | ROLAND
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State | OK
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Zip | 74954-5160
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Country | US
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Telephone | 479-755-5801
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 226
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City | ROLAND
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State | OK
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Zip | 74954-0226
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Country | US
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Telephone | 479-755-5801
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Fax |
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Authorized Official
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Title or Position | OWNER/PROVIDER
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Name | CANDACE RAE JEFFRIES NICHOLS
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Credential | LPC
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Telephone | 479-755-5801
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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 | 4595
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License Number State | OK
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