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General NPI Number Information
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NPI Number | 1285142992
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Entity Type | Organization
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Legal Business Name | GENERATIONS PSYCHOLOGY AND COUNSELING, LLC
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Dates
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Enumeration Date | 01/16/2018
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Last Update Date | 02/01/2018
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Provider Practice Location Address
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Address Line | 5912 W HEFNER RD STE S
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City | OKLAHOMA CITY
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State | OK
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Zip | 73162-4946
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Country | US
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Telephone | 405-659-2403
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 720954
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City | OKLAHOMA CITY
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State | OK
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Zip | 73172-0954
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | SHANTEL MITCHELL-COOLEY
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Credential | LCSW
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Telephone | 405-659-2403
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 1290
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 5827
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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