Provider Demographics
NPI:1235754458
Name:NEW LIFE COUNSELING CENTER
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:WILLIAM
Authorized Official - Middle Name:A
Authorized Official - Last Name:MOORE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:580-736-4455
Mailing Address - Street 1:3405 KRISTIN LN
Mailing Address - Street 2:
Mailing Address - City:DUNCAN
Mailing Address - State:OK
Mailing Address - Zip Code:73533-1801
Mailing Address - Country:US
Mailing Address - Phone:580-736-4455
Mailing Address - Fax:580-786-2079
Practice Address - Street 1:1206 N HWY 81
Practice Address - Street 2:
Practice Address - City:DUNCAN
Practice Address - State:OK
Practice Address - Zip Code:73533-1790
Practice Address - Country:US
Practice Address - Phone:580-475-0014
Practice Address - Fax:580-786-2079
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-06-12
Last Update Date:2020-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
914664849OtherBCBS