Provider Demographics
NPI:1568176741
Name:NEW LIFE COUNSELING ALLIANCE
Entity Type:Organization
Organization Name:NEW LIFE COUNSELING ALLIANCE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:S
Authorized Official - Last Name:WAGUESPACK
Authorized Official - Suffix:JR
Authorized Official - Credentials:BTH, MSW, LCSW
Authorized Official - Phone:580-500-8050
Mailing Address - Street 1:303 N MARKET ST
Mailing Address - Street 2:
Mailing Address - City:CORDELL
Mailing Address - State:OK
Mailing Address - Zip Code:73632-4229
Mailing Address - Country:US
Mailing Address - Phone:580-500-8050
Mailing Address - Fax:888-344-9087
Practice Address - Street 1:603 W GARY BLVD
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:OK
Practice Address - Zip Code:73601-2715
Practice Address - Country:US
Practice Address - Phone:580-500-8050
Practice Address - Fax:888-344-9087
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-01-11
Last Update Date:2023-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty