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General NPI Number Information
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NPI Number | 1861928905
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Entity Type | Organization
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Legal Business Name | THE LAUGHING SHARK, INC.
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Dates
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Enumeration Date | 05/11/2017
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Last Update Date | 08/08/2020
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Provider Practice Location Address
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Address Line | 11212 N MAY AVE STE 107
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City | OKLAHOMA CITY
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State | OK
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Zip | 73120
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Country | US
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Telephone | 405-229-3237
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 20326
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City | OKLAHOMA CITY
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State | OK
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Zip | 73156-0326
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Country | US
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Telephone | 405-229-3237
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DANIELLE J WILLIAMS
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Credential | M.ED, LPC, LADC/MH
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Telephone | 405-519-7471
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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 | 5258
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License Number State | OK
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 1111
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License Number State | OK
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