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General NPI Number Information
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NPI Number | 1174834329
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Entity Type | Organization
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Legal Business Name | CONNECTIONS NLP, LLC
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Dates
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Enumeration Date | 06/23/2010
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Last Update Date | 06/23/2010
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Provider Practice Location Address
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Address Line | 1218 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4416
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Country | US
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Telephone | 580-622-8800
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Fax | 580-622-8805
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Provider Business Mailing Address
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Address Line | 1218 W BROADWAY AVE
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City | SULPHUR
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State | OK
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Zip | 73086-4416
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Country | US
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Telephone | 580-622-8800
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Fax | 580-622-8805
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Authorized Official
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Title or Position | OWNER
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Name | MR. GARY BRUCE SMITH
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Credential | LPC
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Telephone | 580-622-8800
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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 | 4369
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License Number State | OK
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