MEDICARE: MR. PRESTON LYNN SIMS M.ED.

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	7	OK
2	106H00000X	Marriage & Family Therapist	75	OK

General Provider Information

NPI Number	:	1588667703
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MR. PRESTON LYNN SIMS M.ED.

Provider Business Mailing Address
First Line	:	PO BOX 721175
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73172-1175
Country	:	US
Telephone Number	:	405-842-6552
Fax Number	:	405-842-6559

Provider Business Practice Location Address
First Line	:	4334 NW EXPRESSWAY
Second Line	:	STE 266
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73116-1578
Country	:	US
Telephone Number	:	405-842-6552
Fax Number	:	405-842-6559

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/23/2005
Last Update Date	:	02/17/2024

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