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General NPI Number Information
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NPI Number | 1376719716
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Entity Type | Organization
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Legal Business Name | WICHITA COUNSELING CENTER
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Dates
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Enumeration Date | 05/06/2008
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Last Update Date | 05/06/2008
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Provider Practice Location Address
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Address Line | 6217 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5836
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Country | US
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Telephone | 580-353-4357
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Fax | 580-536-5102
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Provider Business Mailing Address
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Address Line | 6217 W GORE BLVD
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City | LAWTON
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State | OK
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Zip | 73505-5836
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Country | US
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Telephone | 580-353-4357
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Fax | 580-536-5102
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Authorized Official
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Title or Position | OWNER
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Name | MS. ARLETA SPYCE STOVER
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Credential | LPC
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Telephone | 580-383-4357
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | 3569
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License Number State | OK
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