Provider Demographics
NPI:1134671951
Name:SHEPHERD'S RECOVERY AND COUNSELING SERVICES
Entity Type:Organization
Organization Name:SHEPHERD'S RECOVERY AND COUNSELING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO AND CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TEMITOPE
Authorized Official - Middle Name:
Authorized Official - Last Name:ROTIMI
Authorized Official - Suffix:
Authorized Official - Credentials:LADC/MH, LPC, ICAADC
Authorized Official - Phone:405-361-5488
Mailing Address - Street 1:7117 E RENO AVE
Mailing Address - Street 2:
Mailing Address - City:MIDWEST CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73110-4444
Mailing Address - Country:US
Mailing Address - Phone:405-361-5488
Mailing Address - Fax:
Practice Address - Street 1:7117 E RENO AVE
Practice Address - Street 2:
Practice Address - City:MIDWEST CITY
Practice Address - State:OK
Practice Address - Zip Code:73110-4444
Practice Address - Country:US
Practice Address - Phone:405-361-5488
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-27
Last Update Date:2016-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OKLADC/MH/1155251B00000X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management