Provider Demographics
NPI:1609457365
Name:MAYES COUNTY COUNSELING AND RESOURCES PLLC
Entity Type:Organization
Organization Name:MAYES COUNTY COUNSELING AND RESOURCES PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:JOHNNY
Authorized Official - Middle Name:DARYEL
Authorized Official - Last Name:CUNNINGHAM
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:918-697-3823
Mailing Address - Street 1:PO BOX 961
Mailing Address - Street 2:
Mailing Address - City:CHOUTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74337-0961
Mailing Address - Country:US
Mailing Address - Phone:918-697-3823
Mailing Address - Fax:918-476-0582
Practice Address - Street 1:119 WEST MAIN
Practice Address - Street 2:
Practice Address - City:CHOUTEAU
Practice Address - State:OK
Practice Address - Zip Code:74337-0961
Practice Address - Country:US
Practice Address - Phone:918-476-4008
Practice Address - Fax:918-476-0582
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-15
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health