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General NPI Number Information
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NPI Number | 1467966952
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Entity Type | Organization
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Legal Business Name | DANCING HAWK COUNSELING, LLC
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Dates
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Enumeration Date | 11/20/2017
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Last Update Date | 11/20/2017
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Provider Practice Location Address
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Address Line | 118 W BROADWAY ST
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City | ALTUS
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State | OK
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Zip | 73521-3816
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Country | US
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Telephone | 580-379-4900
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Fax | 580-379-4921
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Provider Business Mailing Address
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Address Line | 512 QUAIL RUN N
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City | ALTUS
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State | OK
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Zip | 73521-9723
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Country | US
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Telephone | 580-379-4900
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Fax | 580-379-4921
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Authorized Official
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Title or Position | OWNER/ PROFESSIONAL COUNSELOR
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Name | MRS. KRISTINA LYNN MCKUNE
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Credential | M.S., LPC, LADC
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Telephone | 580-379-4900
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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 | 129
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 2729
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License Number State | OK
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