=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962429811
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | NEW VISION PROFESSIONAL COUNSELING, PC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/16/2006
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11212 N MAY AVE SUITE 107
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73120-6336
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-921-7776
-----------------------------------------------------
Fax | 405-603-5309
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 8601 NW 105TH ST
-----------------------------------------------------
City | OKLAHOMA CITY
-----------------------------------------------------
State | OK
-----------------------------------------------------
Zip | 73162-1224
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 405-921-7776
-----------------------------------------------------
Fax | 405-603-5309
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT THERAPIST
-----------------------------------------------------
Name | MR. SHAWN LEE MAGUIRE
-----------------------------------------------------
Credential | LPC, MAMFT, MACC
-----------------------------------------------------
Telephone | 405-921-7776
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YP2500X
-----------------------------------------------------
Taxonomy Name | Professional Counselor
-----------------------------------------------------
License Number | 2098
-----------------------------------------------------
License Number State | OK
-----------------------------------------------------