Provider Demographics
NPI:1275853301
Name:COMMUNITY LEARNING COUNCIL, INC.
Entity Type:Organization
Organization Name:COMMUNITY LEARNING COUNCIL, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:GINGER
Authorized Official - Middle Name:
Authorized Official - Last Name:DECOTEAU
Authorized Official - Suffix:
Authorized Official - Credentials:MS, MED
Authorized Official - Phone:405-751-4219
Mailing Address - Street 1:PO BOX 20414
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73156-0414
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2525 NW EXPRESSWAY
Practice Address - Street 2:SUITE 204
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7227
Practice Address - Country:US
Practice Address - Phone:405-751-4219
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-11
Last Update Date:2010-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health