Provider Demographics
NPI:1386837649
Name:PHOENIX CENTER FOR PASTORAL COUNSELING
Entity Type:Organization
Organization Name:PHOENIX CENTER FOR PASTORAL COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:MELVA
Authorized Official - Middle Name:GAYLE
Authorized Official - Last Name:BRIDGES
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-376-5463
Mailing Address - Street 1:13112 N ROCKWELL AVE
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73142-2717
Mailing Address - Country:US
Mailing Address - Phone:405-376-5463
Mailing Address - Fax:405-376-5843
Practice Address - Street 1:13112 N ROCKWELL AVE
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73142-2717
Practice Address - Country:US
Practice Address - Phone:405-376-5463
Practice Address - Fax:405-376-5843
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK971251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health