Provider Demographics
NPI:1063813863
Name:WRIGHTWAY COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:WRIGHTWAY COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGIE
Authorized Official - Middle Name:D
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:MHR, LPC, CM
Authorized Official - Phone:580-795-4844
Mailing Address - Street 1:16460 MARLOVE RD
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-9547
Mailing Address - Country:US
Mailing Address - Phone:580-795-4844
Mailing Address - Fax:575-267-6243
Practice Address - Street 1:720 N COMMERCE ST STE 634
Practice Address - Street 2:
Practice Address - City:ARDMORE
Practice Address - State:OK
Practice Address - Zip Code:73401-3915
Practice Address - Country:US
Practice Address - Phone:580-795-4844
Practice Address - Fax:575-267-6243
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-11
Last Update Date:2014-09-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5433101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1760704142Medicaid