| NPI | 1639502545 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BONNY PARKHURST Owner / Licensed Counselor 918-202-9432 |
| Organization Subpart ? | No |
| Primary Taxonomy | 302F00000X Exclusive Provider Organization (Licence: OK 5006) |
| Enumeration Date | 2013-08-14 |
| Last Update Date | 2013-08-14 |