Provider Demographics
NPI:1053059337
Name:LEOPARD PRINT THERAPY GROUP LLC
Entity Type:Organization
Organization Name:LEOPARD PRINT THERAPY GROUP LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LPC
Authorized Official - Prefix:
Authorized Official - First Name:SHERITA
Authorized Official - Middle Name:
Authorized Official - Last Name:GIBSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-503-7930
Mailing Address - Street 1:2200 N CLASSEN BLVD STE 702
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-5806
Mailing Address - Country:US
Mailing Address - Phone:405-503-7930
Mailing Address - Fax:
Practice Address - Street 1:2200 N CLASSEN BLVD STE 702
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-5806
Practice Address - Country:US
Practice Address - Phone:405-503-7930
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-05-25
Last Update Date:2022-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty