| NPI | 1619357936 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | JEANETTE LOUDERMILK Clinical Director 405-606-2880 |
| Organization Subpart ? | No |
| Primary Taxonomy | 101YM0800X Counselor, Mental Health (Licence: OK 5120) |
| Additional Taxonomies | 101Y00000X Counselor (Licence: OK 5120) |
| 101YP2500X Counselor, Professional (Licence: OK 5120) | |
| 102L00000X Psychoanalyst (Licence: OK 5120) | |
| Enumeration Date | 2015-06-02 |
| Last Update Date | 2015-06-02 |