Provider Demographics
NPI:1114299534
Name:GROVES, CODY WAYNE (MS, LPC CANDIDATE)
Entity Type:Individual
Prefix:
First Name:CODY
Middle Name:WAYNE
Last Name:GROVES
Suffix:
Gender:M
Credentials:MS, LPC CANDIDATE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:222 E SHERIDAN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73104-4233
Mailing Address - Country:US
Mailing Address - Phone:866-926-6552
Mailing Address - Fax:
Practice Address - Street 1:222 E SHERIDAN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73104-4233
Practice Address - Country:US
Practice Address - Phone:866-926-6552
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-01-31
Last Update Date:2015-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor