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General NPI Number Information
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NPI Number | 1366360729
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Entity Type | Organization
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Legal Business Name | EMOTIONAL INTELLIGENT THERAPEUTIC SERVICES PLLC
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Dates
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Enumeration Date | 07/06/2026
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Last Update Date | 07/06/2026
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Provider Practice Location Address
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Address Line | 1330 N CLASSEN BLVD STE 125
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6834
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Country | US
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Telephone | 405-210-2073
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Fax |
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Provider Business Mailing Address
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Address Line | 1330 N CLASSEN BLVD STE 125
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City | OKLAHOMA CITY
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State | OK
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Zip | 73106-6834
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Country | US
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Telephone | 405-210-2073
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Fax |
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Authorized Official
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Title or Position | CO OWNER/MANAGING CLINICAL DIRECTOR
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Name | MYQUICHE CLAYTON
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Credential | LPC SUPERVISOR
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Telephone | 405-210-2073
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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