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General NPI Number Information
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NPI Number | 1750194825
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Entity Type | Organization
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Legal Business Name | VINEYARD COUNSELING
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Dates
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Enumeration Date | 01/30/2025
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Last Update Date | 01/30/2025
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Provider Practice Location Address
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Address Line | 2626 E 21ST ST STE 4
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City | TULSA
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State | OK
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Zip | 74114-1719
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Country | US
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Telephone | 918-900-2081
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Fax |
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Provider Business Mailing Address
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Address Line | 7378 E 119TH PL S
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City | BIXBY
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State | OK
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Zip | 74008-2044
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MR. ANDREW LAYDEN
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Credential | LPC
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Telephone | 918-230-0021
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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