Provider Demographics
NPI:1699191882
Name:FAITH VALUES COMMUNITY OUTREACH AND COUNSELING SERVICES, INC
Entity Type:Organization
Organization Name:FAITH VALUES COMMUNITY OUTREACH AND COUNSELING SERVICES, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADM. DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MAJORIE
Authorized Official - Middle Name:
Authorized Official - Last Name:MILES
Authorized Official - Suffix:
Authorized Official - Credentials:CCRP,BHCM
Authorized Official - Phone:405-885-6277
Mailing Address - Street 1:3945 SE 15TH ST
Mailing Address - Street 2:SUITE 107
Mailing Address - City:DEL CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73115-2249
Mailing Address - Country:US
Mailing Address - Phone:405-208-8886
Mailing Address - Fax:
Practice Address - Street 1:3945 SE 15TH ST
Practice Address - Street 2:SUITE 107
Practice Address - City:DEL CITY
Practice Address - State:OK
Practice Address - Zip Code:73115-2249
Practice Address - Country:US
Practice Address - Phone:405-208-8886
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2015-10-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK1669191882Medicaid