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General NPI Number Information
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NPI Number | 1295248425
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Entity Type | Organization
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Legal Business Name | THE DYSFUNCTIONAL COUCH
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Dates
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Enumeration Date | 11/09/2017
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Last Update Date | 01/06/2023
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Provider Practice Location Address
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Address Line | 3839 S BOULEVARD STE 200
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City | EDMOND
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State | OK
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Zip | 73013-5495
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Country | US
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Telephone | 918-638-4219
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Fax |
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Provider Business Mailing Address
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Address Line | 3839 S BOULEVARD STE 200
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City | EDMOND
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State | OK
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Zip | 73013-5495
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Country | US
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Telephone | 918-638-4219
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Fax |
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Authorized Official
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Title or Position | OWNER, THERAPIST
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Name | ELIZABETH LOUISE MITCHELL
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Credential | M.ED., LPC
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Telephone | 918-638-4219
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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 | 5358
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License Number State | OK
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