MEDICARE: DYNAMIC COMMUNICATIONS COUNSELING AGENCY

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	261QM0850X	Adult Mental Health Clinic/Center
2	261QM0855X	Adolescent and Children Mental Health Clinic/Center

General Provider Information

NPI Number	:	1013462589
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DYNAMIC COMMUNICATIONS COUNSELING AGENCY

Provider Business Mailing Address
First Line	:	10325 GREENBRIAR PL STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7647
Country	:	US
Telephone Number	:	405-378-3866
Fax Number	:	405-759-3867

Provider Business Practice Location Address
First Line	:	10325 GREENBRIAR PL STE B
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73159-7647
Country	:	US
Telephone Number	:	405-378-3866
Fax Number	:	405-759-3867

Authorized Official
Title or Position	:	CEO
Name	:	BONNIE LOU LOVETT
Credential	:	LPC
Telephone Number	:	405-378-3866

Provider Enumeration Date	:	08/24/2016
Last Update Date	:	08/24/2016

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