MEDICARE: DIVINE HEALING AND FAMILY 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
1	251S00000X	Community/Behavioral Health Agency		OK

General Provider Information

NPI Number	:	1386062198
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	DIVINE HEALING AND FAMILY COUNSELING LLC

Provider Business Mailing Address
First Line	:	8001 MID AMERICA BLVD
Second Line	:	SUITE 400
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-5806
Country	:	US
Telephone Number	:	405-326-9540
Fax Number	:

Provider Business Practice Location Address
First Line	:	8001 MID AMERICA BLVD
Second Line	:	SUITE 400
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73135-5806
Country	:	US
Telephone Number	:	405-326-9540
Fax Number	:

Authorized Official
Title or Position	:	CEO/OWNER
Name	:	MS. FLORENCE CHIME ONYIA
Credential	:	MHR, LPC U/SUPERVISI
Telephone Number	:	405-326-9540

Provider Enumeration Date	:	03/31/2014
Last Update Date	:	03/31/2014

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