MEDICARE: ADVANCE COUNSELING, PC

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	251B00000X	Case Management Agency	2578	OK
2	251S00000X	Community/Behavioral Health Agency	2578	OK

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1104178904
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADVANCE COUNSELING, PC

Provider Business Mailing Address
First Line	:	1015 WATERWOOD PKWY
Second Line	:	SUITE GB2
City	:	EDMOND
State	:	OK
Zip	:	73034-5327
Country	:	US
Telephone Number	:	405-844-8085
Fax Number	:	405-285-1652

Provider Business Practice Location Address
First Line	:	6656 NW 39TH EXPY
Second Line	:	SUITE 202
City	:	BETHANY
State	:	OK
Zip	:	73008-2704
Country	:	US
Telephone Number	:	405-844-8085
Fax Number	:	405-285-1652

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DWIGHT GASTON
Credential	:
Telephone Number	:	405-844-8085

Provider Enumeration Date	:	10/04/2012
Last Update Date	:	10/04/2012

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