Provider Demographics
NPI:1679851174
Name:THE AGENCY AT ZOE
Entity Type:Organization
Organization Name:THE AGENCY AT ZOE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:CORNELIUS
Authorized Official - Middle Name:
Authorized Official - Last Name:PITTS
Authorized Official - Suffix:
Authorized Official - Credentials:MCP, LPC
Authorized Official - Phone:580-278-6151
Mailing Address - Street 1:729 E MAINE AVE
Mailing Address - Street 2:
Mailing Address - City:ENID
Mailing Address - State:OK
Mailing Address - Zip Code:73701-5915
Mailing Address - Country:US
Mailing Address - Phone:580-237-7703
Mailing Address - Fax:580-237-5589
Practice Address - Street 1:729 E MAINE AVE
Practice Address - Street 2:
Practice Address - City:ENID
Practice Address - State:OK
Practice Address - Zip Code:73701-5915
Practice Address - Country:US
Practice Address - Phone:580-237-7703
Practice Address - Fax:580-237-5589
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3653251S00000X, 252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No252Y00000XAgenciesEarly Intervention Provider Agency