Provider Demographics
NPI:1114401387
Name:NORTHSTAR COUNSELING ASSOCIATES, LLC
Entity Type:Organization
Organization Name:NORTHSTAR COUNSELING ASSOCIATES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:VERNER
Authorized Official - Middle Name:DALMOND
Authorized Official - Last Name:GODWIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-623-0154
Mailing Address - Street 1:204 BURK WAY
Mailing Address - Street 2:
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2012
Mailing Address - Country:US
Mailing Address - Phone:405-623-1454
Mailing Address - Fax:
Practice Address - Street 1:4540 E RENO AVE
Practice Address - Street 2:
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73117
Practice Address - Country:US
Practice Address - Phone:405-623-1454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-24
Last Update Date:2018-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK6765101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty