Provider Demographics
NPI:1063661676
Name:OWASSO COUNSELING SERVICES,PLLC
Entity Type:Organization
Organization Name:OWASSO COUNSELING SERVICES,PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:PROF
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:ANN
Authorized Official - Last Name:HARTMULLER
Authorized Official - Suffix:
Authorized Official - Credentials:MA,LPC,LMFT,SAP
Authorized Official - Phone:918-274-7311
Mailing Address - Street 1:PO BOX 956
Mailing Address - Street 2:
Mailing Address - City:OWASSO
Mailing Address - State:OK
Mailing Address - Zip Code:74055-0956
Mailing Address - Country:US
Mailing Address - Phone:918-274-7311
Mailing Address - Fax:918-272-0600
Practice Address - Street 1:8555 N 117TH EAST AVE
Practice Address - Street 2:SUITE 205
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-0000
Practice Address - Country:US
Practice Address - Phone:918-274-7311
Practice Address - Fax:918-272-0600
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-09-18
Last Update Date:2011-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK146101YA0400X
OK2809101YP2500X
OK797106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OKPHARTMULLER3OtherOUT PATIENT BEHAVIORAL/MENTAL HEALTH & SUBSTANCE ABUSE