MEDICARE: NEW DIMENSIONS YOUTH 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	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1619312154
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW DIMENSIONS YOUTH AND FAMILY COUNSELING LLC,

Provider Business Mailing Address
First Line	:	2836 LINDA LN
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5012
Country	:	US
Telephone Number	:	405-609-2310
Fax Number	:	405-609-2310

Provider Business Practice Location Address
First Line	:	2836 LINDA LN
Second Line	:
City	:	DEL CITY
State	:	OK
Zip	:	73115-5012
Country	:	US
Telephone Number	:	405-609-2310
Fax Number	:	405-609-2310

Authorized Official
Title or Position	:	CHIEF EXECUTIVE DIRECTOR
Name	:	FLORENCE CHIME ONYIA
Credential	:	MHR, LPC-U/S
Telephone Number	:	405-609-2310

Provider Enumeration Date	:	05/09/2013
Last Update Date	:	05/09/2013

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