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General NPI Number Information
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NPI Number | 1740510254
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Entity Type | Organization
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Legal Business Name | CORE LIFE COUNSELING CENTER
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Dates
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Enumeration Date | 01/05/2010
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Last Update Date | 01/05/2010
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Provider Practice Location Address
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Address Line | 412 N VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-4453
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Country | US
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Telephone | 580-237-3432
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Fax | 580-237-8433
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Provider Business Mailing Address
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Address Line | 412 N VAN BUREN ST
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City | ENID
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State | OK
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Zip | 73703-4453
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Country | US
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Telephone | 580-237-3432
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Fax | 580-237-8433
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Authorized Official
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Title or Position | LICENSED PROFESSIONAL COUNSELOR
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Name | MS. ANITA CRAWFORD BROWN I
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Credential | LPC
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Telephone | 580-237-3432
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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 | 2054
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License Number State | OK
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