MEDICARE: ITS ALL RELATIVE

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	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1649593492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ITS ALL RELATIVE

Provider Business Mailing Address
First Line	:	3604 SAGE TRAIL CIR
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73179-4819
Country	:	US
Telephone Number	:	405-413-2527
Fax Number	:	405-418-0177

Provider Business Practice Location Address
First Line	:	3240 W BRITTON RD STE 102
Second Line	:
City	:	OKLAHOMA CITY
State	:	OK
Zip	:	73120-2040
Country	:	US
Telephone Number	:	405-413-2527
Fax Number	:	405-418-0177

Authorized Official
Title or Position	:	OWNER
Name	:	MRS. VICKI S. REYNOLDS
Credential	:	M.S., LPC-LMFT
Telephone Number	:	405-413-2527

Provider Enumeration Date	:	03/09/2010
Last Update Date	:	03/09/2010

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1023218468 — GREGORY C KHOURY MD AMPC
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1104135334 — RONDA J. KIEFER LPC
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Directions to “ITS ALL RELATIVE ” Practice Location

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