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General NPI Number Information
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NPI Number | 1811362015
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Entity Type | Organization
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Legal Business Name | CONNECTIONS CENTER FOR GUIDANCE AND DEVELOPMENT, PLLC
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Dates
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Enumeration Date | 12/14/2015
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Last Update Date | 01/22/2016
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Provider Practice Location Address
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Address Line | 4301 NW 63RD ST STE.100
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1549
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Country | US
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Telephone | 405-242-2969
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Fax | 405-421-0818
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Provider Business Mailing Address
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Address Line | 4301 NW 63RD ST SUITE 100
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City | OKLAHOMA CITY
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State | OK
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Zip | 73116-1549
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Country | US
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Telephone | 405-242-2969
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Fax | 405-421-0818
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | SAMANTHA CARLTON
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Credential | LMFT
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Telephone | 405-570-2139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 5550
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1154
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License Number State | OK
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Taxonomy #3
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1173
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License Number State | OK
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