| NPI | 1316255789 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TERRI T SLACK Owner 405-401-1464 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YP2500X Counselor, Professional (Licence: OK 4164) |
| Additional Taxonomies | 101YA0400X Counselor, Addiction (Substance Use Disorder) (Licence: OK 638) |
| Enumeration Date | 2010-09-20 |
| Last Update Date | 2010-09-20 |