Provider Demographics
NPI:1528224110
Name:OKLAHOMA PLAY THERAPY COUNSELING CENTER
Entity Type:Organization
Organization Name:OKLAHOMA PLAY THERAPY COUNSELING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CONNIE
Authorized Official - Middle Name:
Authorized Official - Last Name:O'BRIEN
Authorized Official - Suffix:
Authorized Official - Credentials:ME, D, LPC
Authorized Official - Phone:5802-340-8000
Mailing Address - Street 1:502 W RANDOLPH AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-3828
Mailing Address - Country:US
Mailing Address - Phone:580-234-8000
Mailing Address - Fax:580-234-8000
Practice Address - Street 1:502 W RANDOLPH AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-3828
Practice Address - Country:US
Practice Address - Phone:580-234-8000
Practice Address - Fax:580-234-8000
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-02
Last Update Date:2008-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3802251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health