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General NPI Number Information
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NPI Number | 1134549348
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Entity Type | Organization
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Legal Business Name | RE VISION COUNSELING SERVICES, PLLC
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Dates
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Enumeration Date | 04/27/2014
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Last Update Date | 04/27/2014
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Provider Practice Location Address
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Address Line | 715 W MAIN ST SUITE H
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City | JENKS
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State | OK
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Zip | 74037-3554
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Country | US
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Telephone | 918-995-2233
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Fax | 918-995-2239
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Provider Business Mailing Address
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Address Line | 715 W MAIN ST SUITE H
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City | JENKS
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State | OK
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Zip | 74037-3554
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Country | US
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Telephone | 918-995-2233
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Fax | 918-995-2239
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Authorized Official
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Title or Position | OWNER
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Name | MRS. MARILYN HEINRICHS
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Credential | LPC
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Telephone | 918-955-2239
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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