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General NPI Number Information
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NPI Number | 1841475977
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Entity Type | Organization
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Legal Business Name | INTERACTION COUNSELING
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Dates
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Enumeration Date | 01/08/2008
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Last Update Date | 03/06/2008
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Provider Practice Location Address
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Address Line | 4411 W GORE BLVD STE B10
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City | LAWTON
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State | OK
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Zip | 73505-5977
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Country | US
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Telephone | 580-353-0909
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Fax |
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Provider Business Mailing Address
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Address Line | 4411 W GORE BLVD STE B10
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City | LAWTON
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State | OK
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Zip | 73505-5977
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Country | US
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Telephone | 580-353-0909
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Fax |
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Authorized Official
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Title or Position | SOCIAL WORKER
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Name | JIM JOHNSON
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Credential | LCSW
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Telephone | 580-353-0909
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 36
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License Number State | OK
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