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General NPI Number Information
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NPI Number | 1184883811
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Entity Type | Organization
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Legal Business Name | RURAL AREA COUNSELING CENTER
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Dates
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Enumeration Date | 06/06/2008
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Last Update Date | 06/06/2008
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Provider Practice Location Address
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Address Line | 223 N BROADWAY ST
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City | HOLDENVILLE
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State | OK
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Zip | 74848-3416
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Country | US
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Telephone | 405-379-3505
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Fax | 405-379-3546
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Provider Business Mailing Address
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Address Line | 223 N BROADWAY ST
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City | HOLDENVILLE
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State | OK
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Zip | 74848-3416
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Country | US
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Telephone | 405-379-3505
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Fax | 405-379-3546
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Authorized Official
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Title or Position | CEO
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Name | LISHA DAWN HENSON
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Credential | MS, LPC
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Telephone | 405-379-3505
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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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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