Provider Demographics
NPI:1811362015
Name:CONNECTIONS CENTER FOR GUIDANCE AND DEVELOPMENT, PLLC
Entity Type:Organization
Organization Name:CONNECTIONS CENTER FOR GUIDANCE AND DEVELOPMENT, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SAMANTHA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARLTON
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:405-570-2139
Mailing Address - Street 1:4301 NW 63RD ST
Mailing Address - Street 2:SUITE 100
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73116-1549
Mailing Address - Country:US
Mailing Address - Phone:405-242-2969
Mailing Address - Fax:405-421-0818
Practice Address - Street 1:4301 NW 63RD ST
Practice Address - Street 2:STE.100
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73116-1549
Practice Address - Country:US
Practice Address - Phone:405-242-2969
Practice Address - Fax:405-421-0818
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2016-01-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5550101YP2500X
OK1173106H00000X
OK1154106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty