MEDICARE: AFFINITY COUNSELING SERCIVES, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	4551	OK

General Provider Information

NPI Number	:	1003163296
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	AFFINITY COUNSELING SERCIVES, LLC

Provider Business Mailing Address
First Line	:	PO BOX 57
Second Line	:
City	:	CARNEY
State	:	OK
Zip	:	74832-0057
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	632 W. CENTRAL
Second Line	:
City	:	CARNEY
State	:	OK
Zip	:	74832
Country	:	US
Telephone Number	:	405-612-3121
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR/OWNER
Name	:	PAULA KNOX
Credential	:	LPC
Telephone Number	:	405-612-3121

Provider Enumeration Date	:	08/07/2012
Last Update Date	:	08/07/2012

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