MEDICARE: CALDWELL COUNSELING SERVICES, 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	101YM0800X	Mental Health Counselor
2	1041C0700X	Clinical Social Worker

General Provider Information

NPI Number	:	1376348813
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CALDWELL COUNSELING SERVICES, LLC

Provider Business Mailing Address
First Line	:	3909 SE 29TH ST STE 120
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-2615
Country	:	US
Telephone Number	:	405-588-7817
Fax Number	:

Provider Business Practice Location Address
First Line	:	3909 SE 29TH ST STE 120
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73115-2615
Country	:	US
Telephone Number	:	405-588-7817
Fax Number	:

Authorized Official
Title or Position	:	SOLE MEMBER/OWNER
Name	:	ALEXIS CALDWELL
Credential	:	MHR, LADC, LCSW
Telephone Number	:	405-588-7817

Provider Enumeration Date	:	02/18/2025
Last Update Date	:	02/25/2025

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