Provider Demographics
NPI: | 1528390846 |
---|---|
Name: | MISTI A. CENTER, LPC, LLC |
Entity Type: | Organization |
Organization Name: | MISTI A. CENTER, LPC, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | PROVIDER |
Authorized Official - Prefix: | MRS |
Authorized Official - First Name: | MISTI |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | CENTER |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | LPC |
Authorized Official - Phone: | 918-277-3746 |
Mailing Address - Street 1: | 2504 E 21ST ST STE B |
Mailing Address - Street 2: | |
Mailing Address - City: | TULSA |
Mailing Address - State: | OK |
Mailing Address - Zip Code: | 74114-1759 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 918-277-3746 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 2504 E 21ST ST STE B |
Practice Address - Street 2: | |
Practice Address - City: | TULSA |
Practice Address - State: | OK |
Practice Address - Zip Code: | 74114-1759 |
Practice Address - Country: | US |
Practice Address - Phone: | 918-277-3746 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2010-02-11 |
Last Update Date: | 2010-02-11 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
OK | 3673 | 101YP2500X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 101YP2500X | Behavioral Health & Social Service Providers | Counselor | Professional | Group - Single Specialty |