Provider Demographics
NPI:1497390512
Name:NEXUS COUNSELING SERVICE, LLC
Entity Type:Organization
Organization Name:NEXUS COUNSELING SERVICE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:JACQULINE
Authorized Official - Middle Name:
Authorized Official - Last Name:JACKSON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-919-4061
Mailing Address - Street 1:123 ARMADILLO DR
Mailing Address - Street 2:
Mailing Address - City:NEWALLA
Mailing Address - State:OK
Mailing Address - Zip Code:74857-8666
Mailing Address - Country:US
Mailing Address - Phone:405-919-4061
Mailing Address - Fax:405-360-4561
Practice Address - Street 1:3750 W MAIN ST
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73072-4657
Practice Address - Country:US
Practice Address - Phone:405-919-4061
Practice Address - Fax:405-360-4561
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-13
Last Update Date:2019-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselorGroup - Single Specialty