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General NPI Number Information
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NPI Number | 1629341888
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Entity Type | Organization
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Legal Business Name | HEART OF CHRIST COUNSELING, LLC
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Dates
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Enumeration Date | 02/20/2012
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Last Update Date | 03/13/2012
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Provider Practice Location Address
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Address Line | 1327 S NEW HAVEN AVE
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City | TULSA
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State | OK
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Zip | 74112-5924
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Country | US
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Telephone | 918-720-6629
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Fax |
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Provider Business Mailing Address
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Address Line | 1327 S NEW HAVEN AVE
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City | TULSA
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State | OK
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Zip | 74112-5924
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Country | US
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Telephone | 918-720-6629
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | MR. SHAWN ALYEA
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Credential | LPC
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Telephone | 918-720-6629
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 2201
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License Number State |
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