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General NPI Number Information
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NPI Number | 1427369057
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Entity Type | Organization
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Legal Business Name | WOHL'S COUNSELING CLINIC,LLC
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Dates
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Enumeration Date | 06/29/2010
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Last Update Date | 06/29/2010
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Provider Practice Location Address
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Address Line | 400 E CENTRAL AVE STE.303E
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City | PONCA CITY
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State | OK
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Zip | 74601-5429
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Country | US
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Telephone | 580-762-6511
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Fax | 580-762-6511
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Provider Business Mailing Address
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Address Line | 400 E CENTRAL AVE STE.303E
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City | PONCA CITY
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State | OK
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Zip | 74601-5429
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Country | US
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Telephone | 580-762-6511
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Fax | 580-762-6511
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Authorized Official
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Title or Position | OWNER
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Name | MRS. SAMANTHA JO WOHL
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Credential | LPC
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Telephone | 580-762-6511
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 3745
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License Number State | OK
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