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General NPI Number Information
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NPI Number | 1932580032
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Entity Type | Organization
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Legal Business Name | ADVANCED COUNSELING P.C.
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Dates
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Enumeration Date | 06/15/2015
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Last Update Date | 06/15/2015
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Provider Practice Location Address
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Address Line | 1732 S KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73013-3630
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Country | US
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Telephone | 405-844-8085
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Fax |
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Provider Business Mailing Address
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Address Line | 1732 S KELLY AVE
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City | EDMOND
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State | OK
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Zip | 73013-3630
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Country | US
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Telephone | 405-844-8085
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DWIGHT GASTON
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Credential |
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Telephone | 405-844-8085
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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