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General NPI Number Information
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NPI Number | 1881947489
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Entity Type | Organization
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Legal Business Name | SERENITY COUNSELING, INC.
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Dates
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Enumeration Date | 10/19/2012
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Last Update Date | 10/19/2012
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Provider Practice Location Address
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Address Line | 804 S BROADWAY ST
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City | POTEAU
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State | OK
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Zip | 74953-3834
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Country | US
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Telephone | 580-380-4285
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 433
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City | WISTER
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State | OK
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Zip | 74966-0433
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MR. STACEY GIBSON
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Credential | MBS, LPC-S
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Telephone | 580-380-4285
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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 |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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