Provider Demographics
NPI:1043972144
Name:ASSOCIATION OF CATHOLIC COUNSELORS
Entity Type:Organization
Organization Name:ASSOCIATION OF CATHOLIC COUNSELORS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KEVIN
Authorized Official - Middle Name:GEORGE
Authorized Official - Last Name:STEPHENSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC-S
Authorized Official - Phone:918-406-6682
Mailing Address - Street 1:1216 W HONOLULU ST
Mailing Address - Street 2:
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-7733
Mailing Address - Country:US
Mailing Address - Phone:918-406-6680
Mailing Address - Fax:918-994-7940
Practice Address - Street 1:1216 W HONOLULU ST
Practice Address - Street 2:
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-7733
Practice Address - Country:US
Practice Address - Phone:918-406-6680
Practice Address - Fax:918-994-7940
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-10-06
Last Update Date:2021-10-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100708550Medicaid