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General NPI Number Information
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NPI Number | 1811416977
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Entity Type | Organization
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Legal Business Name | WETHRIVE COUNSELING CENTER PLLC
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Dates
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Enumeration Date | 09/10/2017
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Last Update Date | 07/21/2022
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Provider Practice Location Address
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Address Line | 416 E B ST APT A
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City | JENKS
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State | OK
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Zip | 74037-4157
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Country | US
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Telephone | 918-809-4841
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Fax |
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Provider Business Mailing Address
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Address Line | 416 E B ST APT A
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City | JENKS
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State | OK
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Zip | 74037-4157
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Country | US
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Telephone | 918-809-4841
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | MARI SAMUELSON
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Credential | LCSW
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Telephone | 918-809-4841
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 4509
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License Number State | OK
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