Provider Demographics
NPI:1093248247
Name:MARSHALL COUNTY COUNSELING SERVICES
Entity Type:Organization
Organization Name:MARSHALL COUNTY COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CEO
Authorized Official - Prefix:
Authorized Official - First Name:TANYA
Authorized Official - Middle Name:LAJEAN
Authorized Official - Last Name:MAGNESS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC, LADC
Authorized Official - Phone:580-730-0113
Mailing Address - Street 1:300 E WOLF ST
Mailing Address - Street 2:
Mailing Address - City:MADILL
Mailing Address - State:OK
Mailing Address - Zip Code:73446-2229
Mailing Address - Country:US
Mailing Address - Phone:580-730-0113
Mailing Address - Fax:580-872-4661
Practice Address - Street 1:300 E WOLF ST
Practice Address - Street 2:
Practice Address - City:MADILL
Practice Address - State:OK
Practice Address - Zip Code:73446-2229
Practice Address - Country:US
Practice Address - Phone:580-730-0113
Practice Address - Fax:580-872-4661
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-04-05
Last Update Date:2017-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK845101YA0400X
OK3695101YP2500X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty