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General NPI Number Information
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NPI Number | 1780133827
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Entity Type | Organization
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Legal Business Name | CONNECTIONS COUNSELING GROUP PLLC
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Dates
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Enumeration Date | 09/30/2016
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Last Update Date | 09/30/2016
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Provider Practice Location Address
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Address Line | 1710 S BOSTON AVE
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City | TULSA
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State | OK
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Zip | 74119-4810
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Country | US
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Telephone | 918-280-9698
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Fax |
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Provider Business Mailing Address
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Address Line | 1710 S BOSTON AVE
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City | TULSA
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State | OK
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Zip | 74119-4810
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Country | US
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Telephone | 918-280-9698
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Fax |
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Authorized Official
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Title or Position | CLINICAL DIRECTOR
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Name | MRS. SANDI FULTZ
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Credential | MS,LPC-S
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Telephone | 918-280-9698
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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 | 3283
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License Number State | OK
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