=====================================================
General NPI Number Information
=====================================================
NPI Number | 1821602459
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | PRODUCTIVE COUNSELING SERVICES PLLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/01/2020
-----------------------------------------------------
Last Update Date | 09/10/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4815 S HARVARD AVE STE 418
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-3068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-406-2663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4815 S HARVARD AVE STE 418
-----------------------------------------------------
City | TULSA
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 74135-3068
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 918-406-2663
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MARIANNE JAMES BRETT
-----------------------------------------------------
Credential | LCSW
-----------------------------------------------------
Telephone | 918-406-2663
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------