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General NPI Number Information
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NPI Number | 1992210595
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Entity Type | Organization
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Legal Business Name | POSITIVE AGING COUNSELING AND CONSULTING, LLC
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Dates
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Enumeration Date | 12/05/2017
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Last Update Date | 12/05/2017
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Provider Practice Location Address
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Address Line | 3010 S HARVARD AVE
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City | TULSA
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State | OK
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Zip | 74114-6124
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Country | US
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Telephone | 918-694-5787
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Fax |
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Provider Business Mailing Address
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Address Line | 2220 S INDIANAPOLIS AVE
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City | TULSA
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State | OK
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Zip | 74114-1921
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Country | US
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Telephone | 918-694-5787
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Fax |
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Authorized Official
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Title or Position | LICENSED CLINICAL SOCIAL WORKER
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Name | RACHEL DEATON
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Credential |
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Telephone | 918-694-5787
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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 | 6055
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License Number State | OK
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