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General NPI Number Information
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NPI Number | 1134609563
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Entity Type | Organization
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Legal Business Name | 360 PERIMETER COUNSELING
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Dates
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Enumeration Date | 08/15/2018
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Last Update Date | 08/15/2018
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Provider Practice Location Address
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Address Line | 1741 W 33RD ST STE 100
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City | EDMOND
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State | OK
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Zip | 73013-3838
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Country | US
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Telephone | 405-589-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 3217 N MUELLER AVE
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City | BETHANY
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State | OK
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Zip | 73008-4040
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Country | US
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Telephone | 405-589-8553
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Fax |
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Authorized Official
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Title or Position | THERAPIST
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Name | MS. JESSICA LEIGH HELMKA
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Credential | MA, LADC/MH
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Telephone | 405-589-8553
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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 | 1316
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License Number State | OK
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