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General NPI Number Information
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NPI Number | 1770001224
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Entity Type | Organization
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Legal Business Name | RLL COUNSELING, LLC
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Dates
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Enumeration Date | 09/05/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 333 W MAIN ST STE 242
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City | ARDMORE
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State | OK
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Zip | 73401-6320
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Country | US
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Telephone | 580-490-1440
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Fax | 539-313-9090
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Provider Business Mailing Address
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Address Line | 333 W MAIN ST STE 242
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City | ARDMORE
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State | OK
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Zip | 73401-6320
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Country | US
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Telephone | 580-490-1440
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Fax | 539-313-9090
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Authorized Official
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Title or Position | CLINICAL SOCIAL WORKER
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Name | ROGER LEE LOEWEN
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Credential | MS, LCSW
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Telephone | 580-490-1440
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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 | 4171
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License Number State | OK
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