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General NPI Number Information
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NPI Number | 1497390512
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Entity Type | Organization
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Legal Business Name | NEXUS COUNSELING SERVICE, LLC
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Dates
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Enumeration Date | 11/13/2019
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Last Update Date | 11/13/2019
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Provider Practice Location Address
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Address Line | 3750 W MAIN ST
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City | NORMAN
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State | OK
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Zip | 73072-4657
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Country | US
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Telephone | 405-919-4061
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Fax | 405-360-4561
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Provider Business Mailing Address
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Address Line | 123 ARMADILLO DR
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City | NEWALLA
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State | OK
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Zip | 74857-8666
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Country | US
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Telephone | 405-919-4061
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Fax | 405-360-4561
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Authorized Official
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Title or Position | CEO
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Name | JACQULINE JACKSON
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Credential | LPC
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Telephone | 405-919-4061
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number |
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License Number State |
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