Provider Demographics
NPI:1114382298
Name:SARA DURHAM COUNSELING LLC
Entity Type:Organization
Organization Name:SARA DURHAM COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SARA
Authorized Official - Middle Name:GALE
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-226-2251
Mailing Address - Street 1:1500 S MIDWEST BLVD
Mailing Address - Street 2:STE. 102
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4946
Mailing Address - Country:US
Mailing Address - Phone:405-226-2251
Mailing Address - Fax:
Practice Address - Street 1:1500 S MIDWEST BLVD
Practice Address - Street 2:STE. 102
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4946
Practice Address - Country:US
Practice Address - Phone:405-226-2251
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-16
Last Update Date:2015-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5848101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200458210 CMedicaid