Provider Demographics
NPI:1336491349
Name:OPTIONS CHILD DEVELOPMENT CENTER
Entity Type:Organization
Organization Name:OPTIONS CHILD DEVELOPMENT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EX CLINICAL DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:SHANIQUE
Authorized Official - Last Name:SHOALS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-601-4004
Mailing Address - Street 1:1510 N KLEIN AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73106-4415
Mailing Address - Country:US
Mailing Address - Phone:405-601-4004
Mailing Address - Fax:
Practice Address - Street 1:1510 N KLEIN AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73106-4415
Practice Address - Country:US
Practice Address - Phone:405-601-4004
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OPTIONS UNLIMITED COUNSELING AND CONSULTING
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-15
Last Update Date:2012-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health