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General NPI Number Information
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NPI Number | 1538877865
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Entity Type | Organization
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Legal Business Name | LOVE & LIGHT
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Dates
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Enumeration Date | 11/07/2022
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Last Update Date | 11/07/2022
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Provider Practice Location Address
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Address Line | 10400 VINEYARD BLVD STE E
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120-3830
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Country | US
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Telephone | 405-223-3345
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Fax |
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Provider Business Mailing Address
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Address Line | 4804 TATE DR
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City | DEL CITY
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State | OK
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Zip | 73115-3838
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Country | US
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Telephone | 405-223-3345
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Fax |
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Authorized Official
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Title or Position | LCSW
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Name | RAECHELLE REED
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Credential | LCSW
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Telephone | 405-223-3345
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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