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General NPI Number Information
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NPI Number | 1689459166
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Entity Type | Organization
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Legal Business Name | ABUNDANT GRACE COUNSELING SERVICES, INC.
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Dates
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Enumeration Date | 08/31/2023
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Last Update Date | 08/31/2023
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Provider Practice Location Address
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Address Line | 531 E A ST STE 200B
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City | JENKS
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State | OK
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Zip | 74037-4349
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Country | US
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Telephone | 918-269-9511
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Fax |
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Provider Business Mailing Address
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Address Line | 7220 E 91ST CT
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City | TULSA
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State | OK
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Zip | 74133-5300
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Country | US
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Telephone | 918-269-9511
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MRS. ANALISA PENA
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Credential | LPC
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Telephone | 918-269-9511
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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 |
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License Number State |
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