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General NPI Number Information
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NPI Number | 1811768997
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Entity Type | Organization
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Legal Business Name | COMMON CONNECTION LLC
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Dates
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Enumeration Date | 01/09/2024
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Last Update Date | 01/09/2024
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Provider Practice Location Address
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Address Line | 5300 N MERIDIAN AVE STE 11C
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City | OKLAHOMA CITY
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State | OK
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Zip | 73112-2179
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Country | US
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Telephone | 405-274-9764
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Fax |
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Provider Business Mailing Address
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Address Line | 8001 TAMMY CIR
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City | OKLAHOMA CITY
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State | OK
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Zip | 73132-4155
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Country | US
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Telephone | 405-274-9764
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | TOGA WILLIAMS
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Credential | LPC
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Telephone | 405-274-9764
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0855X
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Taxonomy Name | Adolescent and Children Mental Health Clinic/Center
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License Number |
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License Number State |
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