=====================================================
General NPI Number Information
=====================================================
NPI Number | 1518377761
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ESSENCE OF LIFE COUNSELING SERVICES
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/28/2014
-----------------------------------------------------
Last Update Date | 04/28/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1535 S MEMORIAL DR
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74112-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-660-0255
-----------------------------------------------------
Fax | 918-660-0267
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 1535 S MEMORIAL DR
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74112-7002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-660-0255
-----------------------------------------------------
Fax | 918-660-0267
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CO-OWNER
-----------------------------------------------------
Name | MRS. KATIE M SCOTT
-----------------------------------------------------
Credential | LPC, LADC
-----------------------------------------------------
Telephone | 918-660-0255
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251S00000X
-----------------------------------------------------
Taxonomy Name | Community/Behavioral Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------