Provider Demographics
NPI:1710382866
Name:ELEMENTS OF LIFE COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:ELEMENTS OF LIFE COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:TERRI
Authorized Official - Middle Name:TARRANT
Authorized Official - Last Name:SLACK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC, LADC
Authorized Official - Phone:405-401-1464
Mailing Address - Street 1:1741 W 33RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:EDMOND
Mailing Address - State:OK
Mailing Address - Zip Code:73013-3837
Mailing Address - Country:US
Mailing Address - Phone:405-285-5586
Mailing Address - Fax:405-562-4858
Practice Address - Street 1:1741 W 33RD ST
Practice Address - Street 2:SUITE 100
Practice Address - City:EDMOND
Practice Address - State:OK
Practice Address - Zip Code:73013-3837
Practice Address - Country:US
Practice Address - Phone:405-285-5586
Practice Address - Fax:405-562-4858
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-10-31
Last Update Date:2014-10-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK638101YA0400X
OK4164101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty