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General NPI Number Information
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NPI Number | 1285103796
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Entity Type | Organization
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Legal Business Name | ALTUS FAMILY COUNSELING, LLC
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Dates
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Enumeration Date | 11/14/2018
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Last Update Date | 05/18/2021
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Provider Practice Location Address
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Address Line | 1116 N MAIN ST STE M12
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City | ALTUS
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State | OK
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Zip | 73521-3149
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Country | US
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Telephone | 580-379-0677
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Fax | 580-482-0008
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Provider Business Mailing Address
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Address Line | 1116 N MAIN ST STE M12
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City | ALTUS
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State | OK
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Zip | 73521-3149
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Country | US
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Telephone | 580-379-0677
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Fax | 580-482-0008
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Authorized Official
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Title or Position | CEO/CLINICAL DIRECTOR
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Name | MRS. TRACY JEAN LORAH
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Credential | M.A. LPC
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Telephone | 580-379-0677
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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 |
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License Number State |
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