Provider Demographics
NPI:1346750569
Name:THE MIND, HEART & SOUL COUNSELING ENRICHMENT ORGANIZATION, LLC
Entity Type:Organization
Organization Name:THE MIND, HEART & SOUL COUNSELING ENRICHMENT ORGANIZATION, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:SHEILA
Authorized Official - Middle Name:THELMA
Authorized Official - Last Name:HODGE-WINDOVER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:580-699-7654
Mailing Address - Street 1:PO BOX 7990
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73506-1990
Mailing Address - Country:US
Mailing Address - Phone:580-699-7654
Mailing Address - Fax:
Practice Address - Street 1:1317 SW WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:LAWTON
Practice Address - State:OK
Practice Address - Zip Code:73501-7231
Practice Address - Country:US
Practice Address - Phone:580-699-7654
Practice Address - Fax:580-699-8400
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-10-02
Last Update Date:2017-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)