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General NPI Number Information
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NPI Number | 1811458037
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Entity Type | Organization
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Legal Business Name | COLLABORATIVE COUNSELING OF ENID
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Dates
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Enumeration Date | 03/29/2019
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Last Update Date | 03/29/2019
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Provider Practice Location Address
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Address Line | 301 W. MAINE, SUITE 100 301 W. MAINE, SUITE 100
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City | ENID
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State | OK
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Zip | 73701-5699
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Country | US
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Telephone | 580-231-7099
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Fax | 580-540-9819
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Provider Business Mailing Address
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Address Line | 301 W. MAINE, SUITE 100 301 W. MAINE, SUITE 100
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City | ENID
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State | OK
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Zip | 73701-5669
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Country | US
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Telephone | 580-231-7099
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Fax | 580-540-9819
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. PEGGY ANN DUNSON-BOWER
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Credential | MCP, LPC
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Telephone | 580-231-7099
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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 |
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License Number State |
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