=====================================================
General NPI Number Information
=====================================================
NPI Number | 1851012744
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | COLETTE KAY WARKENTIN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/08/2022
-----------------------------------------------------
Last Update Date | 09/08/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | A CHANCE TO CHANGE 2113 WEST BRITTON ROAD
-----------------------------------------------------
City | VILLAGE
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-840-9000
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 3740 NW 60TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73112-1459
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-414-8979
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 02972
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------