Provider Demographics
NPI:1659781649
Name:FUNDAMENTALS COUNSELING SERVICES,LLC
Entity Type:Organization
Organization Name:FUNDAMENTALS COUNSELING SERVICES,LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:RUSK
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:479-228-1120
Mailing Address - Street 1:994 N MOSELEY RD
Mailing Address - Street 2:
Mailing Address - City:COLCORD
Mailing Address - State:OK
Mailing Address - Zip Code:74338-3383
Mailing Address - Country:US
Mailing Address - Phone:479-228-1120
Mailing Address - Fax:918-723-3730
Practice Address - Street 1:747 HWY 59 #4
Practice Address - Street 2:
Practice Address - City:WESTVILLE
Practice Address - State:OK
Practice Address - Zip Code:74965
Practice Address - Country:US
Practice Address - Phone:918-723-3735
Practice Address - Fax:918-723-3730
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-30
Last Update Date:2014-04-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty