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General NPI Number Information
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NPI Number | 1922483627
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Entity Type | Organization
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Legal Business Name | CONSULTING AND COUNSELING FOR COMMUNITY CHANGE, PLLC
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Dates
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Enumeration Date | 07/22/2015
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Last Update Date | 01/04/2024
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Provider Practice Location Address
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Address Line | 2021 MAHANEY AVE STE 4
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City | TAHLEQUAH
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State | OK
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Zip | 74464-5795
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Country | US
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Telephone | 918-901-9300
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Fax | 918-901-9339
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Provider Business Mailing Address
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Address Line | 1313 CATHY AVE
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City | TAHLEQUAH
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State | OK
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Zip | 74464-6609
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Country | US
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Telephone | 918-772-8466
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | LEVI TAYLOR KEEHLER
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Credential | MS, LPC, LADC/MH
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Telephone | 918-901-9300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 606
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License Number State | OK
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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 | 3992
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License Number State | OK
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