MEDICARE: OKLAHOMA CHRISTIAN COUNSELING CENTER, INC

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1457449746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OKLAHOMA CHRISTIAN COUNSELING CENTER, INC

Provider Business Mailing Address
First Line	:	13301 N MERIDIAN AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-752-9500
Fax Number	:	405-752-9571

Provider Business Practice Location Address
First Line	:	13301 N MERIDIAN AVE STE 100
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-8357
Country	:	US
Telephone Number	:	405-752-9500
Fax Number	:	405-752-9571

Authorized Official
Title or Position	:	CLINICAL DIRECTOR
Name	:	DR. JEANETTE L ZAMBERLIN
Credential	:	PH.D
Telephone Number	:	405-752-9500

Provider Enumeration Date	:	10/11/2006
Last Update Date	:	08/22/2020

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