Provider Demographics
NPI:1629655980
Name:OPTIMUM POTENTIAL COUNSELING SERVICES, LLC
Entity Type:Organization
Organization Name:OPTIMUM POTENTIAL COUNSELING SERVICES, LLC
Other - Org Name:OPTIMUM POTENTIAL COUNSELING SERVICES, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:D
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:405-673-4733
Mailing Address - Street 1:4334 NW EXPRESSWAY STE 189
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1515
Mailing Address - Country:US
Mailing Address - Phone:405-673-4733
Mailing Address - Fax:
Practice Address - Street 1:4334 NW EXPRESSWAY STE 189
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1515
Practice Address - Country:US
Practice Address - Phone:405-673-4733
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-24
Last Update Date:2024-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty