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General NPI Number Information
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NPI Number | 1104435288
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Entity Type | Organization
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Legal Business Name | SCISSORTAIL COUNSELING SERVICES, LLC
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Dates
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Enumeration Date | 07/24/2020
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Last Update Date | 08/04/2020
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Provider Practice Location Address
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Address Line | 1800 E MEMORIAL RD STE 102
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City | OKLAHOMA CITY
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State | OK
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Zip | 73131-1827
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Country | US
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Telephone | 405-625-1665
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Fax |
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Provider Business Mailing Address
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Address Line | 3317 MEADOW LN
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City | EDMOND
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State | OK
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Zip | 73013-5420
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Country | US
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Telephone | 405-625-1665
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | SAMANTHA MASQUAT
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Credential | LADC/MH
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Telephone | 405-625-1665
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number |
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License Number State |
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