Provider Demographics
NPI:1114058070
Name:CHARLES B GODDARD HEALTH CENTER COUNSELING AT THE UNIVERSITY OF OK
Entity Type:Organization
Organization Name:CHARLES B GODDARD HEALTH CENTER COUNSELING AT THE UNIVERSITY OF OK
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:WAYNE
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:405-325-2700
Mailing Address - Street 1:620 ELM AVE RM 201
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73019-3142
Mailing Address - Country:US
Mailing Address - Phone:405-325-2911
Mailing Address - Fax:405-325-1478
Practice Address - Street 1:620 ELM AVE RM 201
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73019-3142
Practice Address - Country:US
Practice Address - Phone:405-325-2911
Practice Address - Fax:405-325-1478
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-09
Last Update Date:2016-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health