Provider Demographics
NPI:1790960672
Name:FRESH START COUNSELING SERVICES INC
Entity Type:Organization
Organization Name:FRESH START COUNSELING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:THERESA
Authorized Official - Middle Name:DENISE
Authorized Official - Last Name:BOWLER-SHOPEYIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC CANDIDATE
Authorized Official - Phone:405-487-8134
Mailing Address - Street 1:4801 N CLASSEN BLVD
Mailing Address - Street 2:SUITE 159
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73118-4627
Mailing Address - Country:US
Mailing Address - Phone:405-487-8134
Mailing Address - Fax:405-601-8890
Practice Address - Street 1:4801 CLASSEN BOULEVARD
Practice Address - Street 2:SUITE 159
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73108
Practice Address - Country:US
Practice Address - Phone:405-487-8134
Practice Address - Fax:405-601-8890
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-09
Last Update Date:2008-01-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1912150892251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health