Provider Demographics
NPI:1225406895
Name:INTERNATIONAL BUSINESS ENTERPRISE, IBE
Entity Type:Organization
Organization Name:INTERNATIONAL BUSINESS ENTERPRISE, IBE
Other - Org Name:A1 EXCELLENT COUNSELING SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT / DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:THEOPHILUS
Authorized Official - Middle Name:AMANGAETEOGO
Authorized Official - Last Name:DEPONA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-922-0045
Mailing Address - Street 1:2705 SUMMER SET TRL
Mailing Address - Street 2:
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73012-6642
Mailing Address - Country:US
Mailing Address - Phone:405-922-0045
Mailing Address - Fax:
Practice Address - Street 1:5714 S WESTERN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73109-4515
Practice Address - Country:US
Practice Address - Phone:405-922-0045
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:INTERNATIONAL BUSINESS ENTERPRISE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2015-09-12
Last Update Date:2015-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK302848101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty