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NPI Code Detail

MEDICARE: PATRICK'S SYCAMOORE COUNSELING LLC

MEDICARE: PATRICK'S SYCAMOORE COUNSELING 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
1101YP2500XProfessional Counselor

General Provider Information

NPI Number : 1003634080
Entity Type Code : Organization
Provider Name (Legal Business Name) : PATRICK'S SYCAMOORE COUNSELING LLC
Provider Business Mailing Address
First Line : 3508 GRIZZLY RIDGE CT
Second Line :
City : YUKON
State : OK
Zip : 73099-3576
Country : US
Telephone Number : 405-816-0343
Fax Number :
Provider Business Practice Location Address
First Line : 3908 N PENIEL AVE STE 500
Second Line :
City : BETHANY
State : OK
Zip : 73008-3402
Country : US
Telephone Number : 405-603-3265
Fax Number :
Authorized Official
Title or Position : OWNER
Name : PATRICK JAMES MOORE
Credential : LPC
Telephone Number : 405-816-0343
Provider Enumeration Date : 09/30/2024
Last Update Date : 09/30/2024

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