Provider Demographics
NPI:1255491494
Name:LEQUITA J. JOYCE INC
Entity Type:Organization
Organization Name:LEQUITA J. JOYCE INC
Other - Org Name:ROLAND FAMILY COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRES.
Authorized Official - Prefix:MR
Authorized Official - First Name:PAUL
Authorized Official - Middle Name:EDWIN
Authorized Official - Last Name:GROSE
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:918-427-1311
Mailing Address - Street 1:PO BOX 378
Mailing Address - Street 2:
Mailing Address - City:ROLAND
Mailing Address - State:OK
Mailing Address - Zip Code:74954-0378
Mailing Address - Country:US
Mailing Address - Phone:918-427-1311
Mailing Address - Fax:918-427-0013
Practice Address - Street 1:100 EAST RAY FINE BLVD
Practice Address - Street 2:
Practice Address - City:ROLAND
Practice Address - State:OK
Practice Address - Zip Code:74954
Practice Address - Country:US
Practice Address - Phone:918-427-1311
Practice Address - Fax:918-427-0013
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-11
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100744310AMedicaid