Provider Demographics
NPI:1447785100
Name:TREECE COUNSELING AND THERAPEUTIC PLAY SERVICES
Entity Type:Organization
Organization Name:TREECE COUNSELING AND THERAPEUTIC PLAY SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED PROFESSIONAL COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:KLINTON
Authorized Official - Middle Name:
Authorized Official - Last Name:TREECE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, RPT
Authorized Official - Phone:918-282-6770
Mailing Address - Street 1:PO BOX 52128
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74152-0128
Mailing Address - Country:US
Mailing Address - Phone:915-282-6770
Mailing Address - Fax:
Practice Address - Street 1:10310 N 138TH EAST AVE
Practice Address - Street 2:SUITE 101
Practice Address - City:OWASSO
Practice Address - State:OK
Practice Address - Zip Code:74055-4604
Practice Address - Country:US
Practice Address - Phone:918-282-6770
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-01
Last Update Date:2017-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5795251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health